Getting The Love You Want Signup Form

Your Name (please make this the name of the person paying for the workshop below).*

First Last

Address*

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Phone

Email*

Enter Email Confirm Email

Your partner's name*

First Last

Your partner's email

Enter Email Confirm Email

Your partner's phone number

How did you find out about this workshop?*

Which workshop date do you want to sign up to?*

Conditions for registration*

Please tick the box below to indicate you fully agree to abide by these conditions.

I understand that £150 of this payment is non-refundable if I cancel and the full price of the course will be non refundable if I cancel with less than 28 days notice of the course date.

Please sign us up for one couple's place on the 'Getting the Love You Want' workshop

Price: £ 550.00

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Card Number Expiration Date Security Code Cardholder Name

Total

£ 0.00

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