Healthy Earth Training Institute Semester Registration and Deposit

Healthy Earth Training Institute
Registration and Deposit (Current or Future Semester)
Before filling out this form, gather a photo to upload for us and we will use the photo on your ID Card. Photo should be a close up of your face, and have a neutral background (if possible).
Your Full Name

First NameLast Name
Your Phone Number

Area CodePhone Number
Your Email Address
Your Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Last 4 of Your Social Security Number
Who Referred You?
Upload Your Photo

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We encourage you to become a Healthy Earth Healing Center Practioner. In this event, you will be required to Verify your Identiy and Submit to a Background Check. This will be done under a separate Application Form.
Do you intend to become a Healthy Earth Healing Center Practitioner?
I understand and agree that my $500 Deposit is Non-Refundable and Non-Returnable
Refunds may be issued provided request is made within 24 hours of payment. Refunds are subject to a 5% ($25) Cancellation Fee.
I will Submit my Full Payment for the Course or or Before the Semester Start Date
I understand that my payment for the Course is Non-Refundable and Non-Returnable

Deposit

$500.00

Healthy Earth Training Institute