Registration Form: The Metaphysical Institute

Instructions Summary (click here for Detailed Instructions):
To Enroll-Register, fill out this Registration Form online, then
1) print it and mail it to us or 2) fax it to us.
To Pay: 1) fax your Visa /Mastercard data to us or
2) mail a check or 3) Wire Transfer

Identification
Last Name:
First Name:	Mid. Initial:
Social Security Number (USA only):
Non-USA citizens: Your national or state indentification number:

Please provide two 1.5 X 1.5-inch color photos of yourself (head shots) for your Identification Card. You may mail these separately.

Phone & Email
Day Phone:		Email Address:
Home Phone:		Fax :

Addresses
Street Address:	Apt. Number :
City :	State: Zip:
Province :	Country :
	How long at this address?

Mailing Address Skip if same as above:	Apt. Number :
City :	State: Zip:
Province :	Country :

Previous Address:	Apt. Number :
City :	State: Zip:
Province :	Country :
	How long at this address?

Education
Name of High School Attended (skip if you have a college degree): Year Completed:	If you did not graduate, provide year of completing your GED or High School Equivalency :

Names of Colleges or Universities Attended:	Your Major :

Highest Degree Earned :Bachelor Masters Doctorate | Year :

Provide proof of graduation from either high school or higher institution. You may mail or fax these separately.

Livelihood
Your Occupation:
Employer Name:	Employed How Long?
Address :
City :	State: Zip:

Background

Have you ever taught or held credentials to teach or counsel with any religious or Metaphysical organization?

Yes

If so, please give name of organization and length of time you were so occupied:

Do you have typing / computer skills?

Yes

Rate your public speaking ability :

Childhood religious upbringing was in :

Adult religious affiliation has been with :

How long have you studied
Metaphysics and related subjects?

Describe your present state of health :

Do you, or have you ever had a
drinking or drug problem?

Yes

Give Two Personal References

(REF. 1) Name :	Phone:
Address :	Apt. Number :
City :	State: Zip :
Province :	Country :

(REF. 2) Name :	Phone:
Address :	Apt. Number :
City :	State: Zip :
Province :	Country :

Give an Account of Your Experiences in Metaphysics

Explain how you began your metaphysical studies. State what you plan to achieve from this curriculum or degree. ( It may be easier if you first write out your response in a word processing program and then paste your text into the text field below. If PRINTING this form to mail in, use as many additional sheets of paper as needed to write out [print, type] your response.)

Select a Course-Option for Taking Courses

(All students have access to all materials for all course-options. Materials are the same for all options)

Option 1: Online Courses (via this website)
NOTE: Our courses will soon be online. If you select this option, you will be a Correspondence Student until our courses are online, then you will be switched)

Option 2 : Correspondence Courses (via regular mail)
Option 3 : On-site Courses (on site at physical location, in person)

Select the Semester-Program You Are Applying For

(Semester-Programs must be completed in the order listed)
Tuition & fees must be paid upon registration for each program)

Semester 1: Personal Development Program
Semester 2: Quantum Healing Program
Semester 3: Mediumship /Psychic Sensitivity Program
Semester 4: Doctoral Program I
Semester 5: Doctoral Program II
Semester 6: Doctoral Program III

Cost for Each Semester-Program: Registration Fee:	$ 1,333.00 $ 150.00
Total Cost & Amount To Pay	$1,483.00

Indicate Your Payment Method
Visa /Mastercard Information Faxed Check /Money Order Mailed	Wire Transfer

Signature If mailing or faxing form :	.....................................................................................................
	Date : .....................................................

MAIL or FAX filled-out Registration Form, with your 2 photos, proof of high-school or college graduation, and check (if paying by check) to:

The Metaphysical Institute
7549 Cram Road
Highland, California 92347 USA
FAX: (909) 425-8784
Phone: (909) 864-8740