ENROLLMENT FORM     Step 1: Please complete and submitting the enrollment form below.     Step 2: Email a current CV or resume to sbizal@drbizal.com.     Step 3: To purchase (online or by check) the wellness certification or wellness coaching certification program that you wish to attend...please scroll to the bottom of the page.   Step 4: Confirmation will be sent by email within 24 hours upon receipt of completed enrollment, CV/resume, and payment.      Thank you and congratulations on taking a valuable step to EmPOWER both your career and your personal health! The fields marked with (*) are required fields. * Source: How did you hear about the Wellness Coaching Institute ?  * required * First Name  * required * Last Name  * required * Address Line 1  * required * Address Line 2  * required * City  * required * State  * required * Zip Postal Code  * required * Country United States Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaidjan Bahamas Bahrain Banglades Barbados Belarus Belgium Belize Benin Bermuda Bolivia Bosnia-Herzegovina Botswana Bouvet Island Brazil British Indian O. Terr. Brunei Darussalam Bulgaria Burkina Faso Burundi Buthan Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Rep. Chad Chile China Christmas Island Cocos (Keeling) Isl. Colombia Comoros Congo Cook Islands Costa Rica Croatia Cyprus Czech Republic Czechoslovakia Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Estonia Ethiopia Falkland Isl.(Malvinas) Faroe Islands Fiji Finland France France (European Ter.) French Southern Terr. Gabon Gambia Georgia Germany Ghana Gibraltar Great Britain (UK) Greece Greenland Grenada Guadeloupe (Fr.) Guam (US) Guatemala Guinea Guinea Bissau Guyana Guyana (Fr.) Haiti Heard & McDonald Isl. Honduras Hong Kong Hungary Iceland India Indonesia Iraq Ireland Israel Italy Ivory Coast Jamaica Japan Jordan Kazachstan Kenya Kirgistan Kiribati Korea (North) Korea (South) Kuwait Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique (Fr.) Mauritania Mauritius Mexico Micronesia Moldavia Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherland Antilles Netherlands Neutral Zone New Caledonia (Fr.) New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Isl. Norway Oman Pakistan Palau Panama Papua New Paraguay Peru Philippines Pitcairn Poland Polynesia (Fr.) Portugal Puerto Rico (US) Qatar Reunion (Fr.) Romania Russian Federation Rwanda Saint Lucia Samoa San Marino Saudi Arabia Senegal Seychelles Sierra Leone Singapore Slovak Republic Slovenia Solomon Islands Somalia South Africa Soviet Union Spain Sri Lanka St. Helena St. Pierre & Miquelon St. Tome and Principe St.Kitts Nevis Anguilla St.Vincent & Grenadines Sudan Suriname Svalbard & Jan Mayen Is Swaziland Sweden Switzerland Tadjikistan Taiwan Tanzania Thailand Togo Tokelau Tonga Trinidad & Tobago Tunisia Turkey Turkmenistan Turks & Caicos Islands Tuvalu US Minor outlying Isl. Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Vatican City State Venezuela Vietnam Virgin Islands (British) Virgin Islands (US) Wallis & Futuna Islands Western Sahara Yemen Yugoslavia Zaire Zambia Zimbabwe Other * Telephone Number  * required * Email Address  * required * Company  * required * Position  * required   Current responsibilities within your organization * Which Wellness Certification Course are you interested in enrolling? Wellness/Lifestyle Medicine I Certification (24 hours) @ $2995 Wellness/Lifestyle Medicine II Certification (24 hours) @ $2995 Wellness/Lifestyle Medicine III Certification (24 hours) @ $2995 Wellness/Lifestyle Medicine IV Certification (28 Hours) @ $2995 Wellness/Lifestyle Medicine Certification (100 hours) @ $9995 Wellness & Healthy-Aging I" Coach Certification (8 hours) @ $1495 Wellness & Healthy-Aging II" Coach Certification (16 hours) @ $2495 "Blueprint for Corporate Wellness" Certification (8 hour) @ $1995 "Corporate Wellness Coach" Certification (16 hour) @ $2995 "Chief Wellness Officer" (CWO) Certification (24 hour) @ $3995 Wellness Mastery Retreat - Executive @ $4995 Wellness Mastery Retreat - Health Professional @ $6995   Goals & Objectives: please share what you hope to accomplish with this Wellness Certification Program?
Licensed Health Professional (MD, DO, ND, DC, DrPH, PhD, LAc)  Purchase online... (Programs may be purchased separately or as a package) Wellness/Lifestyle Medicine & Healthy-Aging "I"   @ was $2995...now $1995   Buy Now! Wellness/Lifestyle Medicine & Healthy-Aging "II"  @ was $2995...now $1995   Buy Now! Wellness/Lifestyle Medicine & Healthy-Aging "III" @ was $2995...now $1995   Buy Now! Package Price Special for 2010* (You Save $990 when you purchase all three session) * "Wellness/Lifestyle Medicine & Healthy-Aging" all 3 sessions  @ $4995...   Buy Now!     or Pay by Check... Make your check payable to: The Bizal Group, Inc. Mail your check to: The Bizal Group, Inc., 4533 MacArthur Blvd., Ste.A #166, Newport Beach, CA 92660	Health & Fitness  Instuctors (CCN, RN, MFT, CMT, Certified Fitness-Yoga-Pilates)  Purchase online... (Programs can be purchased separately or as a package) Wellness & Healthy-Aging "I"   @ $1495...   Buy Now! Wellness & Healthy-Aging "II"  @ $1495...   Buy Now! Package Price* (Save $500) * Wellness & Healthy-Aging "I" & "II" @ $2495...   Buy Now!     or Pay by Check... Make your check payable to: The Bizal Group, Inc. Mail your check to: The Bizal Group, Inc., 4533 MacArthur Blvd., Ste.A #166, Newport Beach, CA 92660	Human Resource Professionals  Purchase online... (Programs may be purchased separately or as a package) Corporate Wellness Coach "I"   @ $1495...   Buy Now! Corporate Wellness Coach "II"  @ $1495...   Buy Now! Chief Wellness Officer "CWO"  @ $1495...   Buy Now!  Package Price* #1 (Save $500) * Corporate Wellness Coach "I" + "II" @ $2495...   Buy Now! Package Price** #2 (Save $990) ** Corporate Wellness Coach "I" + "II" + "CWO" @ $3495... Buy Now! or Pay by Check... Make your check payable to: The Bizal Group, Inc. Mail your check to: The Bizal Group, Inc., 4533 MacArthur Blvd., Ste.A #166, Newport Beach, CA 92660
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