NSIR Technologies Enrollment form.

School of Alternative Healing
Enrollment Form

Personal information:
Last Name:	First Name:
Middle Name:	Maiden Name:
Address:	City / State:
Zip Code:	Country:
Day phone #:	Night phone #:
E-mail:
NOTE: You must have a valid e-mail address for acceptance into the program. To get your free e-mail account with Yahoo click here and then sign up.
Social Security #:	Sex (Circle one.): Male / Female
How much schooling have you had? (Check mark one.) High School student High School Graduate Vocational school / Some college Associates degree Bachelors degree Advanced degree (please list any held licenses of medicine on separate page)
Payment information:
Please choose from the following: I am enclosing my $15 non-refundable application fee at this time. I am also enclosing a copy of my last year's tax return; I am requesting a payment plan for the $300 tuition. I have enclosed the entire cost of $335 to cover both the $15 non-refundable application fee and the $300 tuition expense.
Term: May 2022 / Introduction to Nerve Signal Interference Removal (3 credit hours)
Signature:	Today's date:

Instructions:

For your convenience please print this entire page. Then complete and send the enrollment form, and include payment by check or Money Order in US DOLLARS made out to Tammy Kennedy, and snail mail to:

NSIR Technologies School
of Alternative Healing
May 2022 / Introduction to Nerve Signal Interference Removal
3109 W. Neilson Drive
Enid, OK 73703

You are considered enrolled when either payment has been received or a payment plan is agreed upon. NOTE: The entire payment must be received before the end of the class session. If you default on the agreement then the grade and related credit hours are revoked.

Please send us:

A. The completed form.
B. A copy of your driver's license or other proof of identification.
C. Copies of transcripts for all other schools attended.
D. Payment.

If you require special payment options on the tuition, please submit a copy of last year's tax return along with your intent to pay, to be considered for another plan.

This page was first posted on September 6, 2001 and last revised on April 10, 2022.