Registration Form for the “Building Healthy Male-Female Relationships” Seminar

Name:

Email Address:

Phone Number:

Select Your Investment Option:
Seminar Investment – INDIVIDUAL – $49.00 Seminar Investment – COUPLE – $79.00

If someone is joining you as part of “the couple” package, what is that person’s name?

To ensure this seminar meets your desired outcomes, do answer the following 7 questions:

2. Why did you select your answer to question #1? (Do share your reasons)

3. What are your top three (3) outcomes that you hope to achieve by attending this seminar?

4. From your perspective, what is the “ideal” relationship?

5. What are your best characteristics?

6. What are your greatest accomplishments / proudest moments in 2010?

7. Do you believe it’s possible for you to experience a healthy and loving, life-long relationship? (Do share your reasons)

We believe in customizing our programs to ensure that each seminar participant receives the most value possible. Thank you for sharing your insights with us because you will TRULY enjoy this seminar. Remember, we guarantee it!

Click the Payment link below to be taken to the PayPal payment link. You’ll be able to pay via PayPal or credit card.

Thank you for sharing with us and helping us get to know you better! Please click the Payment link below to be taken to the PayPal payment link. You’ll be able to pay via PayPal or credit card. If you wish to pay by check, please email us.