REGISTRATION FORM

We apologize, but we are experiencing technical difficulties! 
If after clicking "SUBMIT", an ERROR shows, you will need to follow the below instructions for FAXING or SNAIL-MAILING in your registration. 
An alternative is to scan the completed form and email it to me to: carol@acenter4growth.com. 
 

To pay online please proceed to http://acenter4growth.com/register-paypal.htm. Thanks for your patience!

OPTION #1
Pay online via PayPal.
 Fill out form below. When finished, click on the "SUBMIT" button below. You will be directed to the PayPal page for your payment info.		   OPTION #2
Pay with a check or Money Order.
Fill out form below. When finished, click on the "SUBMIT" button below. Then mail your check to Carol Anderson. (Contact info below.)
 
Name:
Partner's Name: (Couples' Workshop)
Address:
City:

State:

  

Zip:

  
Phone (h):
Phone (w):  
Workshop:
Workshop Dates:
Minus Discounts:
Buddy's name: (Single's Workshop.)
Total Due:
How did you find my workshop?:  please specify:

I/We have read and understand the Cancellation Policy
Enclosed is my check. (Please print form and snail-mail to Carol.)
I am paying by PayPal. (See Instructions below.)
Please charge my Credit Card. (Please fill out the info below then print, fax, or snail-mail this registration form to Carol.  It is NOT recommended that you email your credit card info. However, you may instead, phone your credit card info into Carol's confidential voicemail.)

Account #
Exp. Date
 
Exact Name & Billing Address, if different from above:

Upon receipt of your registration, I will send you a confirmation letter with details of the weekend. Do you prefer your letter to be:

Emailed - Address:
Snail-mailed  

Congratulations! You have taken an important first step in beginning the Journey to the Relationship of Your Dreams! 

Carol A. Anderson, LMFT
Mail: 8483 N. Millbrook #101, Fresno, CA 93720
Fax: (559) 431-1550
 Phone: 559-487-2444     Toll Free: 800-692-7016

 

Instructions: When you are finished filling out the above form, click the "SUBMIT REGISTRATION" button below. Your registration will be emailed to Carol and you will be sent to a "Form Confirmation" page.

IMPORTANT NOTE! If you want to pay by credit card instead of PayPal, please do NOT include that info on the above form. Clicking "SUBMIT" will email the form, and your info will be in cyberspace FOREVER and accessible by billions!  Please phone your c/c info to me at the above phone number instead.

 If you are paying by PayPal, you will need to click on the "PayPal" link to proceed and complete your registration.

Note: When paying by PayPal, do not include your Credit Card info on the form above.
 
 

 

Workshop Cancellation/Refund Policy:

If I cancel, your fee will be refunded in full.
If you cancel up to 30 days prior to the workshop,  you will be refunded minus a 10% administrative fee.
After that, the fee/deposit is non-refundable. However, you will be allowed to transfer once to another workshop within 12 months for a 10% administration fee.
 You may also donate your workshop to my "Scholarship Fund" for a couple in need. Your donation will be anonymous.
If you "no-show" or leave early, your fee is non-refundable/non-transferable.
Location may be changed, but the workshop will always be in the mountains if a mountain area is advertised. 
If date is changed you are under no obligation to maintain your agreement.
If you are unclear about the above or need further clarification, please email me.

Click here for the RESTS Cancellation Policy.

 

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