+44 7766 820285 info@eloiseansell.com

BreakThrough Seminar Registration Form

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Please note if you wish to pay by credit card we will need this form completed by hand.

Student Information:

This address will be used for manual sending, so please ensure you write in full if you are receiving a manual
  • Full postal address
Please give method of payment: Default will be PayPal. Interac (Canadian’s only). To pay by Visa/MasterCard/AMEX we will need this form completed manually.

Conditions and Fine Print. Please read and sign:

1) Current IBA membership is required for monitoring fee – 25% of the Regular Price

2) $100US non-refundable deposit is required to hold your space and open your file

3) Early Bird must be paid 30 days in advance of the course start date. The Early Bird is non-refundable. You will have a credit for any course with Terryann Nikides.

4) All personal information will remain private and confidential for instructor and IBA’s use only.

5) Once the course commences there is no refund. The course begins the day of the introductory talk.

7) By attending the class you are agreeing to be recorded. IBA contractual requirements dictate we must record (as explained in the audio release & other forms).

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