Rhine Education Center: Introduction to Parapsychology Application

Personal Information

* First Name

Middle Name

* Last Name

* Street Address

Address Line 2

* City

State

Zip Code

* Country

* Day Phone

* Evening Phone

* Email Address

* Date of Birth (month/day/year)

Educational Background

* 1. Select the highest level of education achieved.

* 2. If you have earned a degree, what degrees have you earned or what are your areas of concentration?

0/400 characters

3. If you have had many psychic experiences or work professionally using ESP, please provide a BRIEF description of how this relates to your interest in classes in parapsychology. (Optional)

0/400 characters

* 4. Please write a few sentences describing why Parapsychology is important to you.

0/400 characters

* 5. What areas of parapsychology interest you most?

0/400 characters

Technology Experience

* 1. Please indicate your level of experience with the internet.

* 2. Please indicate your level of experience with reading and posting information to an online forum.

How do I get online?

I’ve heard of forums or blogs.

I’ve read information on a blog or forum.

I’ve contributed to a blog or forum.

I’ve created an online forum or blog.

* 3. Please indicate how comfortable you are with viewing online presentations that last more than one hour.

* 4. Please indicate how comfortable you are with posting in a private and secure online discussion forum related to the course material.

* 5. Have you ever viewed a course using Webex software before?

Yes

No

I'm not sure

* 6. Do you have access to a computer that meets the minimum system requirements for this course? (Click Minimum System Requirements to view the detailed technology requirements for this course.)

Yes

No

I'm not sure

General Information

* What made you choose Rhine Education Center for your studies in parapsychology?

0/400 characters

* How did you hear about Rhine Education Center?

0/400 characters

* I understand that this is an academically oriented class and that all course materials are in English. By checking this box, I certify that I can comprehend resources like academic textbooks, articles, and presentations with my understanding of English.

I understand

* I am interested in receiving additional information via email about courses or events sponsored by the Rhine Education Center and its affiliates.

I understand

DISCLAIMER: This course does not teach psychic abilities, but rather focuses on the scientific efforts related to paranormal activities. Completing this course should not be considered as a qualification to offer or perform psychic services.

Electronic Signature

By typing my name below and submitting this application, I am confirming that all of the information provided in this application is accurate to the best of my knowledge. I am also expressing an interest in attending a course offered by the Rhine Education Center.

I also confirm that I understand that although there is no such thing as complete privacy when it comes to using the internet, all information provided on this application will be considered confidential and will be securely maintained by the Rhine Education Center. The Rhine Education Center, The Rhine Research Center, and all of the employees and associates of this center will be held harmless in the event of an inadvertent breach of confidentiality.

* Electronic Signature

* Date

All information is the sole property of the Rhine Research Center and cannot be reproduced or reused without the expressed written permission of the Rhine Research Center.

This form requires a $15.00 non-refundable application fee. You can pay with PayPal using a credit card even if you don't have a PayPal account, or you can pay by check.

After your application has been reviewed and accepted you will be required to pay the remaining balance. Tuition is $240 (standard tuition), or $195 (members and students enrolled in a degree program).

Thank you!

* I agree to pay this non refundable application fee.

Application Fee $15.00

* Indicates Response Required