Know Thy Self: Group Workshop Series
Customer Details:
E-mail
*
example@example.com
Full Name
*
First Name
Last Name
Phone Number
*
Format: (000) 000-0000.
Are you at least 18 years old?
Please Select
yes
no
Are you a college student (includes all trades, community colleges, etc.)?
Please Select
yes
no
** College students will receive 50% off when registering in advance.
Have you attended a support group or group therapy in the past?
*
Yes, I have attended groups in the past.
No, I have not.
I understand and agree to the 6-week commitment for this program. I acknowledge that the full registration fee ($300 or $150 for college students) is payable regardless of the number of meetings attended. The payment plan requires that the remaining balance be paid by week 2 of the group series.
*
Yes I understand and agree. I will pay in full.
I understand and am requesting a payment plan for the registration fee. I will pay the deposit today ($150 or $75 for college students).
I understand that the deposit and all payments made for the workshop are non-refundable, regardless of the number of sessions attended.
*
Yes I understand and agree.
Submit
Should be Empty: