Print this form, fill it out and mail it in.

    Name  ______________________________________________________________

    Address _____________________________________________________________

    City _________________________________ State _______  Zip ______________

    Phone ___________________________ Email _____________________________

Dr. Carbone is registered with the State of California, Bureau of private
postsecondary and vocational education.

    ___ PAST LIFE CERTIFICATION PROGRAM - $395

    ___ CLINICAL HYPNOTHERAPIST CERTIFICATION PROGRAM- $295

    ___ CERTIFIED LIFE COACH PROGRAM- $395

    ___ HOLISTIC HEALING CERTIFICATION PROGRAM - $395

    ___ PSYCHIC COUNSELOR CERTIFICATION PROGRAM - $195

    ___ E.T. ABDUCTION COUNSELOR CERTIFICATION PROGRAM - $195

    ___ CERTIFIED ANIMAL COMMUNICATOR STUDY COURSE - $195

    _____ Total

    Paying by __ check    __ money order    __ credit card

    credit card # _________________________________    exp. date ______  

    signature _____________________________________________________

    Send registration form to:

    International Association of Past Life Therapy

    Attention Dr. Carole Carbone Dept. I

    12400 Ventura Blvd. #116

    Studio City, CA 91604

Questions? Call us at 818-786-8675