Counseling Services
From Family Interplay Education
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Counseling Services From Family Interplay Education |
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 Registration Form for Couples Workshop October 4th and 5th, 2008 (please copy and send to the address at the bottom of
page) Date _____________________________
Name____________________________________________________________________________ Name
____________________________________________________________________________ Street Address
_____________________________________________________________________ City ___________________________State_____________________Zip________________ Tel: Day______________________
Eve___________________
Fax_______________________ E-mail
______________________________________________________________________________ Registration Fee (please check one): Registration requires payment and a phone interview with each person in the couple Early Registration: $425 per couple
(if registered more than three weeks prior to workshop date, ) Standard Registration: $475 per couple
(if registered less than three weeks prior to workshop date) Payment Information:
Do Not Send Cash I will send you my
check for $ ___________
(payable to Family Interplay Education) Registration can also be done by phone or fax Contact: Family Interplay Education Fax 425-576-8274 8011 118th Ave NE Phone 425 889-8524 #6 Kirkland, WA 98033
Cancellation policy: If cancellation is made on or before the Early Registration Cut Off Date, a full refund minus a $50 processing fee will be given. After October 1, 2008 the payment will go toward a future workshop. |
