Contents: MIND BODY ANTI AGING TREATMENT, ANTI-AGING THERAPYAnti-Aging International Academy, brain, mind, body Longevity Therapist Diploma Course, Anti-Aging franchise, wellness, Therapist, Course, brain mind body, Academy neurocoaching liceisning and franchise,

 Content: anti-aging therapy course, coaching, anti-aging, anti-aging franchise, course, franchise anti-aging course, anti-aging coaching, anti-aging license,
 
 
 
   

                     
 
   

 
   

World's most recognized Anti-Aging Therapist Course and Treatment Services..
   
       
 
 


LICENSING USE of our proprietary ANTI AGING SERVICES:
 - Clinic's Treatment Program
- Academy's Longevity Therapist Course
   APPLICATION FORM
 
 
 
     
 
 
 

 
APPLICATION FORM
   

______________________________________________________________________________________
                  
 

             -   Yes!  - I wish to apply for a SINGLE USER Course Territorial License to conduct the Anti-Aging
                                   Self Transformational Therapy Credentialing Coaching Course and provide course
                                   graduates ICC Certification :
                                -   As a stand-alone Accredited Course (Campus Format) including rights to change
                                          course to best suit my local markets needs.
                                -   Incorporate my existing allied services/products within the Course and modify
                                          the course content eg; adding my own course material.

                                               --  or / and --

             -   Yes!  - I wish to apply for a SINGLE USER Practice Territorial License to use the Anti-Aging
                                  Self Transformational Therapy Credentialing Coaching Course's proprietary tools,
                                  techniques, practice and client materials  etc :
                      -  in my existing practice / business
                                -  to help establish a a new practice / business

                               Some Details:

                 .- I wish to apply for a Single User License for one License:
                               - I Year License Fee - $us2,350.00 or
                              - 3 Year License Fee - $us4,850.00 

                 .- I wish to apply for a Single User License for the two Licenses:
                               - I Year License Fee - $us3,850.00 or
                              - 3 Year License Fee - $us7,850.00

                  .- I require a special quotation, as I am part of a Company and we wish to apply for an
                          internal Multi User License:             
                                                               Some Details - including number of Users:
                                       

             > - Yes! I understand all Users of the Program need to first enrol in the Course (E-Learning format).
                               A Special Rate of $us1650 (Normal Business Rate is $us2,895 ) is provided to obtain the Therapy
                               Diploma and become ICC Accredited. Special Rates available for more than 3 Users.
 
                            *Define your preferred geographic Licensing region within a Country...
                                  

  
                         I would also like to book a telephone call with Dr Zeus to discuss my application.

 
 
Personal / Business Profile:  
   

 

Full Name:

 

Business Name:

 

Address & Zip:

 

State & Country:

 

Tel. #'s:

Home/Mobile:   Biz:

 

Email :

Biz: Personal:
   
Website :
Facebook Name:
   
 

Profession /  Position :

     
     Do you currently provide any professional or personal development courses?  Yes   No  

 
 

Your Professional / Educational Background / 'People Development Experience':

 

 

 

 Size and type of your practice / business:

 

 

Why you would be a suitable License Holder:

   

 Any Referral Names etc to support your application:
 

   

Any additional Information:


 
  
 

 

  

 
 
 
   
 
     

 

    


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Founding Board Member of International Coaching Council
 
Behavioral Coaching Institute. Graduate School of Neuroscience