Please provide the information requested below. Upon form submission and payment, your registration will be processed and enrolled in the corresponding program. An e-mail receipt will be sent immediately following submission.
Name
*
First Name
Last Name
Email
*
example@example.com
Follow Up Session
*
Anger Management
Domestic Violence
Positive Strategies for Life
PSFL Select One
*
None currently available.
Select One
*
Wednesday February 25th, 2026 at 6pm
Total Payment Due:
Session Fee
*
prev
next
( X )
Follow Up Session
$
20.00
Total
$
0.00
Credit Card
By clicking "submit", your registration in the program above will be complete. Login details are provided within the confirmation email you will receive immediatly following submission of this form. All payments are non-refundable.
Submit
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