PSI Leadership Seminar* Men's Leadership Seminar* Choose Your Attendance Date Nov 13th - 20th, 2021 USA Mar 19th - 20th, 2022 USA Aug 27th - Sep 3rd, 2022 USA Nov 5th - 12th, 2022 USA No Date
Women's Leadership Seminar* Choose Your Attendance Date Oct 16th - 23rd, 2021 USA (Waitlisted) Apr 2nd - 9th, 2022 USA Jun 25th - Jul 2nd, 2022 USA Oct 8th - 15th, 2022 USA No Date
Attendee Information Name*
First
Last
Preferred Name (if different than above)
First
Last
Address*
Email* Best Way to Contact Me: I consent to receive communications from PSI Seminars:* May include phone, email, or social media.
Gender* Select Option Male Female Non-Binary
Preferred Gender Pronoun Are you pregnant?* Date of Birth* Marital Status* Select Option Single (never married) Married or Domestic Partnership Divorced Widowed Separated
Number of Children* Select Option 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Level of Education* Select Option Grammar School High School or Equivalent Vocational/Technical School Some College Associate's Degree Bachelor's Degree Master's Degree Doctoral Degree Professional Degree (MD,JD,etc.)
Where did you attend the PSI Basic?* Select Option Atlanta, GA Austin, TX Boise, ID Boston, MA Calgary, AB Dallas, TX Denver, CO Edinburgh, UK Fort Wayne, IN High Valley Ranch, CA Honolulu, HI Houston, TX Lake Havasu, AZ Las Vegas, NV Los Angeles, CA New York, NY Online Orange County, CA Orlando, FL Phoenix, AZ Portland, OR Provo, UT San Diego, CA San Francisco, CA Santa Fe, NM Sarasota, FL Seattle, WA St Louis, MO Tampa, FL Temecula, CA Toronto, ON Vancouver, BC Washington, DC Other/Unknown
Date Attended PSI Basic* Date Attended PSI-7 Life Success Course* Where did they attend the PSI Basic?* Select Option Atlanta, GA Austin, TX Boise, ID Boston, MA Calgary, AB Dallas, TX Denver, CO Edinburgh, UK Fort Wayne, IN High Valley Ranch, CA Honolulu, HI Houston, TX Lake Havasu, AZ Las Vegas, NV Los Angeles, CA New York, NY Online Orange County, CA Orlando, FL Phoenix, AZ Portland, OR Provo, UT San Diego, CA San Francisco, CA Santa Fe, NM Sarasota, FL Seattle, WA St Louis, MO Tampa, FL Temecula, CA Toronto, ON Vancouver, BC Washington, DC Other/Unknown
What do you want to accomplish by participating in this course?*
Confidential Health Questionnaire Do you have any history of psychiatric disorder?* Have you been institutionalized for mental illness within the last twelve months?* Have you undergone treatment by a psychiatrist or psychologist in the last 6 months?* Please explain any of the above marked "yes"*
PSI Leadership Seminar Terms and Conditions TERMS AND CONDITIONS* Class size is limited, and payment in full does not guarantee a seat in the class. If the class is at capacity you will be placed on a waitlist. Once your registration is complete a representative will contact you to confirm your status.
I have read, understand, and agree to the Terms and Conditions.
ARBITRATION CLAUSE* If a dispute arises out of or relates to this contract, or the breach thereof, and if said dispute cannot be settled through direct discussion, the parties agree at first endeavor to settle the dispute in an amicable manner by mediation administered by the American Arbitration Association under its Commercial Mediation Rules, before resorting to arbitration. Thereafter, any unresolved controversy or claim arising out of or relating to this contract, or breach thereof, shall be settled by arbitration administered by the American Arbitration Association in accordance with its Commercial Arbitration Rules, and judgement upon the reward rendered by the arbitrator(s) may be entered in any court having jurisdiction thereof.
I have read, understand, and agree to the Arbitration Clause.
PSI ADVANCED SEMINAR TUITION POLICY* I understand that payment for any PSI Advanced Course is non-refundable/non-transferable. All monies held must be utilized within 12 months from the date of the initial payment or it is forfeited. If I choose to attend a date other than the seminar I am registered for and have not notified the Main Office in writing prior to 30 days before the start of the seminar, I understand that I am subject to an administrative fee of $1000.
I have read, understand, and agree to the Tuition Policy.
HAWAII WAIVER* The law in Hawaii is drafted to protect those who deposit money to attend a sensitivity awareness group seminar by granting the student the right to cancel the course before the first day of the course and obtain a refund of sums paid less $50. We have the obligation to disclose this right to you.
I waive my entitlement to a refund under Hawaii law.
Attendee Signature* I have answered all questions truthfully, and I have read, understand and agree to all policies and clauses contained within.
Payment Details PSI Leadership Seminar USA* Registration Code Be sure to click "Apply" after entering your code!
Payment Status: {entry:payment_status} ${entry:payment_amount} {entry:currency} 04/04/2025
