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registration form

HOME> Professional Training> registration form

Copy and paste the form below into an email and then fill out and send.
(copy by clicking and dragging across the form from top to bottom.)

Registration for Professional Emotional Clearing Facilitator Certification

Name (As you want it to appear on your certificate):

Address (Where to send your certificate):

Phone: Work & Home:


Date of Birth:

Skype ID (Can provide later if don't have now):

Current Profession including Website if have:


How do you envision using your Certification?


Other Professional Credentials / Relevant Life Experience (not req'd for cert.):


Anything Else:



email to:
Put EC TRAINING in the email subject line

Please go to the ORDERING page and submit the deposit of $350. We will notify you that your deposit has been received.


© 2004 John Ruskan / The Institute for Emotional Clearing