Registration Form for  Couples Workshop

 March 20 and 27, 2010
(please copy and send to the address at the bottom of page)

Date _____________________________

Name____________________________________________________________________________

Name ____________________________________________________________________________

Street Address _____________________________________________________________________

City ___________________________State_____________________Zip________________

Tel: Day______________________  Eve___________________   Fax_______________________

E-mail ______________________________________________________________________________ 

      Registration requires payment and a phone interview with each person in the couple

Early Registration:  $475 per couple;  Standard Registration: $525 per couple  (after March 13)

Payment Information: Do Not Send Cash

   my check  is enclosed for $ ___________     (payable to Family Interplay Education)  or

Registration can also be done by phone or fax

Contact:

Family Interplay Education                         Fax                   425-576-8274

8011   118th Ave NE                                    Phone            425 889-8524  #6

Kirkland, WA 98033  

 Cancellation policy:  If cancellation is made on or before the Early Registration Cut Off Date, a full refund minus a $50 processing fee will be given.  After March 13, 2010 the payment will go toward a future workshop.