PAIRS Passage to Intimacy

To Register for the workshop, either click on the PayPal button below
or PRINT OUT this Registration Form and follow the instructions below.

The next workshop meets on Saturday, September 29, 2012
(additional program information is below this Registration Form)

Names: _____________________________________________________________

Email Address: ________________________________

Mailing Address: ________________________________

City: ____________________________ State: _____

Zip: _____________

Home Phone: ___________________________

Work Phone: ___________________________

Program Fee: ________________

PAYMENT METHOD (circle one):

Check Full Payment Money Order Full Payment Cash Full Payment

Credit Card Full Payment

Credit Card Information:

Credit Card (circle one): Visa MasterCard

Card Number: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

Expiration Date: ________________

Mail (or fax to 248-548-1925) completed form with check, money order or credit card information to:

RELATIONSHIP INSTITUTE
27172 Woodward Avenue
Suite 200
Royal Oak, MI 48067

All registered participants will receive a confirmation letter, map and guidelines for how to best prepare for the program.

Registration Information for Workshop

DATES

Passage to Intimacy meets on Saturday, September 29, 2012 from from 9:00 a.m. - 5:00 p.m.

LOCATION

The workshop is held in the Relationship Institute at
27172 Woodward Avenue, Suite 200, Royal Oak, Michigan. See map on web site under "Location".

PROGRAM FEES

The fee for the program is $295 per couple. Anyone who has attended ten or more psychotherapy sessions at the Relationship Institute receives an additional $25 discount. The program comes with 100% money back guarantee.

There is also a $25 discount for each additional couple you register with.

HOW TO REGISTER

Four Easy Ways to Sign Up:

1. Call our office at: (248) 546-0407 Monday - Thursday, 9:30 a.m. to 3:30 p.m.

2. Use a credit card with PayPal:

3. FAX your registration to: (248) 548-1925 (24 hours a day)

4. Mail your registration to:

Relationship Institute
27172 Woodward Avenue, Suite 200
Royal Oak, Michigan 48067

GUARANTEE

We want this program to work for you and we stand behind it completely. Therefore, Passage to Intimacy comes with a full 100% money-back guarantee. Register for the program, pay in full, and apply the program materials in your relationship for six months. If after that you are not satisfied with the results of the program, we will refund your program fee in full.