Untitled Form

Please Read the Cancellation Policy

Name

• Address
• City
• State
• Zip
• Phone (h)
• Phone (w)
• Workshop
  Couples Yosemite Workshop $747 Couples Hounds Tooth Inn $697 Singles Fresno Workshop $347
• Workshop Dates
• Minus Discounts
• Buddy's Name (for singles workshop)
• Total Due
• How did you find my workshops?
  Referred by a therapist From a friend Link from another website Search Engine Online ad Yellow Pages
• I/we have read and understand the Cancellation Policy Yes I understand the cancellation policy
• Paying by check or money order. (Please print form and mail to Carol) Yes Check
• Paying by PayPal (See instructions below) Yes PayPal
• Please charge my credit card. Yes Creditcard

• (Fill out the information below and fax or mail this registration form to Carol. This is not a secure email server so do not email your credit card information. You may also phone your credit card information to Carol's confidential voice mail.)

• Credit Card Account Information (DO NOT EMAIL)
• Expiration Date
• Name Address and billing if different than above.
• Upon receipt of your registration, I will send you a confirmation letter wiht details of the weekend. Choose a method of delivery:
  By mail By email (enter email below)
• Email Address

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" button below. Your registration will be emailed to Carol.

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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