HeartMath® Interventions Certification Program Application

Last Updated on Wednesday, 12 October 2011 11:55 Written by HeartMath Wednesday, 26 January 2011 14:35

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Before submitting your application, please review the HeartMath Interventions Certification Agreement you will be required to sign upon acceptance into the program. Once we receive your application, a HeartMath® representative will contact you to discuss program details and answer your questions. The cost of the program that includes manual, emWave Desktop, emWave2 and the four Transformiing series books is $1,295.

We recommend that you compose your answers to the questions in a word processing program prior to completing the form and then copy and paste them into the form. Once you click the 'Submit Application' button or close your browser you will not be able to access a partially completed form so it's best to complete the entire process when you are ready to submit the form.

First Name
Last Name
Title
Company
Shipping Address
City
State/Province (*If the address is in the US or Canada, please enter a valid 2-letter abbreviation. If the address is not in the US or Canada, please leave blank.)
Zip
Country
Email
Daytime Phone
Mobile Phone
Please list the professional license (s) or credential (s) you currently hold:
Type:
Number and State:
Expiration Date:
Type 2:
Number and State 2:
Expiration Date 2 :
Program description for student in an academic or professional track:
Institution and type of research where HeartMath protocols will be used:
Where do you treat most of your clients or patients? Please include facility name and address:
How do you describe the majority of patients/clients you treat?:
Please list professional references:
Name:
Title:
Professional Relationship:
Email or Phone:
Please indicate how you prefer your name to appear on your certificate. e.g. Janet Connor, Ph.D. :

HeartMath® Interventions Certification Program Application

HeartMath® Interventions Certification Program Application

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