GTLYW Reg Form « Carol A. Anderson

We have read the above Cancellation Policy and we both:*

understand and agree to it.
have questions, so will contact Carol.
do not agree, so will not be registering.

Your Name*

First Last

Your Partner's Name*

First Last

This workshop must be attended by either 2 partners, friends or colleagues sitting in as each others "partners."

Address*

Street Address City State ZIP Code

Your Phone*

Your Email*

How did you find my workshop?*

Please select from below:

Available 2016 Workshop dates:*

Workshop Full Tuition:

Price:

(See available discounts below.)

Available Early-Bird Discounts*

Please select the discount BELOW that applies. (Previous Grads, please see additional Grad discounts.)

GTLYW Workshop Grad Discount:

Couples' Workshop Grads: BOTH partners must be grads to qualify for the FULL $200 discount. If you are both Grads, but need or prefer new manuals, please select the $100 discount. If only one partner is a grad, you may take $100 off and both will receive new manuals.

$200 Discount - We are BOTH Grads and will use our old manuals.
$100 Discount - We are BOTH Grads but will need NEW manuals.
$100 Discount - Only one of us is a Grad so we will BOTH need new Manuals.

For Getting the Love You Want Workshop GRADS discount:

Please list approximate date, presenter(s) & location for your previous Couple's workshop BELOW. This info will be confirmed.

Mental Health Professional Discount

This discount is ONLY for Psychiatrists, Psychologists, Licensed Clinical Social Workers, Marriage & Family Therapists & Substance Abuse Counselors. NURSES are also eligible for this discount.

$100 Additional Discount until October 31

For above discount, please list your License type & Number:

Other Discount: (Please state the discount and amount you are eligible for)

Above discount is only for couples to whom Carol has given permission for an additional discount or scholarship.

TOTAL DUE AT CHECKOUT*

Please enter the amount you owe, minus any discounts you have taken:

Please select how you will pay, then follow the below directions:*

We are paying by PayPal (recommended.)
We are mailing a check today.
Please call us so we can pay over the phone with our card.

PLEASE READ & FOLLOW ALL THESE IMPORTANT DIRECTIONS BEFORE PROCEEDING!

PAYPAL INSTRUCTIONS: (You do not have to belong to PayPal to complete this transaction.)
- Click SUBMIT button at the bottom this page, to submit your form to Carol
- Then click the PayPal "DONATE" button, which is the only Paypal button that allows you to adjust your fee;
- Click "Check out with PAYPAL" and one of the following:
--- 1.) CLICK "LOGIN TO PAYPAL", if you HAVE a PayPal account, or,
--- 2.) If you do NOT have a PayPal account, CLICK "Pay with Debit, Credit or PayPal Credit";
- Now you can pay with your debit card, credit card, or, if you ALREADY QUALIFIED, the 6-mo. INTEREST-FREE PayPal Credit Plan.
***REMEMBER to ENTER your total due from the TOTAL BOX on this page when you get to PAYPAL.

PERSONAL CHECK: If you are paying by check, make sure you mark the "Check" box above. Then please mail to Carol A. Anderson, MFT ~ 7760 N. Fresno St. #103 ~ Fresno, CA 93720 TODAY! When I receive your check, I will email you a link to the confirmation page and hotel info. Please allow 10 business days for this process. If the workshop is prior to that, please contact me.

REMEMBER: SPACE IS LIMITED & RESERVED ON A FIRST-COME/FIRST-SERVED BASIS. Your space will NOT be reserved until your FULL payment is RECEIVED.

Upon successful completion of PayPal payment, you will be taken to my CONFIRMATION website with more info, including hotel reservation details. SAVE THAT LINK!

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Getting the Love You Want Registration Form