Yes, I'll help or join the World Hypnosis Organization, Inc. (WHO)

Enclosed is my check or money order number _______________ for $___________ in U.S. funds made payable to the World Hypnosis Organization, Inc.

Bill my credit card for $_________._____
American Express______ Discover_____ Master Card_____ Visa_____
Number:___________________________ Expires:________________
(To pay by credit card, please check appropriate card, indicate card number, expiration date and sign below. Name & Signature must be the same as on the card.)

I agree to abide by the regulations and code of ethics of the World Hypnosis Organization, Inc.

The World Hypnosis Organization, Inc. does not discriminate against anyone regardless of race, religion, handicap, nationality, or gender. The WHO reserves the right to refuse a contribution or anyone.

I want to be in the following division:

_______Friend -- Who makes tax deductible contributions.

_______Affiliate -- Who has less than 300 hours of training. The yearly cost is $100.

_______Professional -- Who has 300 hours of training, passed a proficiency exam, and gets 25 hours of continuing education per year. The cost per year is $200.

(Please Print Clearly) Date___________________

Name__________________________________

Address________________________________

City___________________________________

State________________ Zip_______________

Phone Number (____)_______-_____________

Fax Number(_____)_______-______________

Signed_________________________________