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Register for Upcoming Event

Event: "The Power of Intimacy"
Date: March 25, 2006
Time: 9:00 am - 1:00 pm
Location: Reed Academy for Engineering
Cost: $150/per couple $75/per single

To map directions to the event click here.
Download the brochure (Adobe pdf document) to obtain detailed information on the seminar.
If you don't have Adobe Acrobat you can download from their website.

Please fill out all of the fields completely to register for the event and then complete the payment information. Payment for this event is handled by PayPal merchant account system.

First Name:
  *
Last Name:
  *
Are you attending as a couple?
  Yes No
Mailing Address:
  *
City:
  *
State:
  *
Zip Code:
  *
Phone:
  *
Email Address:
 
     
Have you ever been to counseling?
  Yes  No
     
Are you currently having any of these problems in your relationship?

Select all that apply.
 

Financial
Communication
Sexual
Infidelity

     
   


 
 
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