Weekend Couples Workshop - February 16 & 17, 2019
Please fill out our registration form with your information below to register for the Art & SCIENCE of Love, Gottman Weekend Couples Workshop, held at the Nevada Relationship Center in Henderson, NV on February 16th & 17th, 2019.
Note: After completing form, you will then click button below to proceed to our Payment Options page where you will either pay by credit card or link to our Check Payment Form - please print, complete, and return with your check
First Name #1
Last Name #1
Name 1 Daytime Phone
Name 1 Evening Phone
Name 1 Email
First Name #2
Last Name #2
Name 2 Daytime Phone
Name 2 Evening Phone
Name 2 Email
Address Line 1
Address Line 2
District of Columbia
Armed Forces (the) Americas
Armed Forces Europe
Armed Forces Pacific
Army Post Office (U.S. Army and U.S. Air Force)
Fleet Post Office (U.S. Navy and U.S. Marine Corps)
Credit Card (Use PayPal Payment Options Below)
Check (Information Provided Once Form Is Submitted)
Early Registration (Before January 19, 2019) - Per Couple
Super Early Registration (Before December 22nd, 2018)
Standard Registration (After January 19, 2019) Per Couple
If one or both partners are licensed therapists (License # Required) there is a $75 discount whenever you register
How did you hear about the Couples Workshop?
Internet Search - like google or yahoo
National Marriage Seminars
Therapist, Counselor or Pastor
Other - Please describe below
Clinician? Please provide Title and License Number.
Please describe how you heard about the Couples Workshop...
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