Course Registration Form

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Name
First Name
Middle Name
Last Name
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Birth Date
Month
Day
Year
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E-mail
example@example.com
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Mobile Number
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Phone Number
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Work Number
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Company
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Courses
Please Select
Please Select
Chakra Certification
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What is your profession?
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Are you a Life Coach?
Yes
No
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If so, what are you areas of specialty?
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Are you a Licensed Clinician?
Yes
No
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If so, what are you areas of specialty?
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Do you currently see clients or have a caseload?
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How many clients do you see a week?
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Are you able to identify 3-4 clients to use for case study during the program?
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Why did you select this course? How do you feel this course can benefit you?
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Rate your knowledge of the Chaka System ( 1 -low 5-high )
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2
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5
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Course Payment Options
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ORDER SUMMARY
Total costUSD
Chakra Coach Program Fee
$3,333.00Edit
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Payment Plan Payment #13 payments of $1111- 2nd payment must before course begins March 2, 2023. 3d payment due June 2023. Payment arrangements will be made upon 1st payment.
$1,111.00Edit
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Early Bird Discount Price$200 discount if paid before 2/3/23.
$3,111.00Edit
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Total cost $0.00
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