필링굿클럽 (Feeling Good Club)

필링굿클럽

Feeling Good Club
Your Information (본인 정보)
Full Name(한국어) *
Full Name(영어) *

First Name Last Name
Gender (성별) *

Male(남자) Female(여자)
Date of Birth (생년월일) *

Month Day Year
Date
Phone Number (전화번호) *
E-mail(이메일) *
example@example.com
Address(집주소) *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Marital Status (결혼 여부)

Single(미혼) Married/Remarried (기혼) Divorced (이혼) Widowed (사별)
Marital Relationship (부부 친밀도)

Good (상) Fair (중) Poor (하)
Number of Children (자녀수)
Intimacy between Parent and Child(ren) (자녀와의 친밀도)

Good (상) Fair (중) Poor (하)
Average Annual Income (연간 수입)

$0-$30,000 $30,000-$50,000 $50,000-$80,000 Above $80,000
How did you hear about Family Touch program? (이 프로그램을 어떻게 접하게 되셨습니까?) *

패밀리터치 교육/상담 (FT Educations/Counseling) 이메일 홍보 (Email Advertisement) 친구/지인 (Friend/Acquaintance) 카톡, SNS (Facebook, Instagram, Missyusa, etc.) 신문 (Newspaper) 교회 (Church) 기타 (Other)
Payment (수업료 결제)
Payment Options (결제 방법) *

Credit Card Check or Cash
Payment By Check or Cash (체크 또는 현금 결제)

수업료: $100

Please make the check payable to "Family Touch" and mail it to Family Touch office "218 Main Steet, Little Ferry, NJ 07643"

체크를 "Family Touch"앞으로 발행하셔서 위의 오피스 주소로 발송해 주십시오.

오피스에 오셔서 직접 현금으로 결제하셔도 됩니다.

Payment By Credit Card (Feeling Good) *

Feeling Good Club_8 weeks

$ 100.00

Total

$ 0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty:

필링굿클럽

Your Information (본인 정보)

Payment (수업료 결제)