I hereby apply for enrollment in Karl Albrecht International's Mindex Certification Course (on-line version). I understand that acceptance of my application is contingent on a review of my professional qualifications (as provided below or otherwise supplied), and that enrollment may be refused to applicants who are judged not suitable. If accepted, I'll receive my User ID and Password by e-mail to the e-mail address supplied below.

Upon completing the on-line course, including submission of a final quiz and confirmation of acceptance of the ethical standards for use of Mindex, I'll receive a certificate which entitles me to purchase and use the Mindex Thinking Style Profile and related products from Karl Albrecht International. My credit card, as provided below, will only be charged if I'm accepted for enrollment. I understand that, once I access the on-line Mindex Certification Course, my enrollment fee is not refundable.

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(*) In One Paragraph, please summarize your professional qualifications here (current occupation, organization, credentials, experience, business operation, etc.):