GETTING THE LOVE YOU WANT

Date of Workshop Required SELECT DATE OF WORKSHOP 2008 April 25-27, 2008 CANCELLED for family medical May 23-25, 2008 For Gay & Lesbian Couples Orlando July 25-27, 2008 For Couples Orlando September 12-14, 2008 Gay & Lesbian Couples Orlando October 10-12, 2008 Couples Orlando December 5-7, 2008 Couples Orlando

Total Fee per couple is $650 US dollars.
Fee includes workshop program, manuals and refreshments. Hotel and meals are NOT included in the fee. Information on accomodations will be sent to you. If you prefer, you can hold your place with a deposit of $300. If you refer another couple to this workshop and they attend, you can attend for $400. If you refer 2 couples who attend, you can attend for FREE!

If you are referring couples to the workshop and are entitled to this reduced price, please put their names here:

Couple Referred:
Couple Referred:

If you are being referred by another person attending the same workshop,
please put their name here:

CANCELLATION: If you cancel 8 or more days prior to the workshop, you will receive a full refund. If you cancel 7 days or less prior to the workshop, you will receive a refund minus $100 administrative fee since we incur the expense of the manuals.

BILLING	You may also send a check or Money Order for payment by mail.
Which Credit Card? Required	VISA MASTERCARD AMERICAN EXPRESS
Cardholder name Required
Card number Required
3 or 4 digit code (3 on back of MC & Visa, 4 on front of Amex) Required
Expiration date Required
Zip Code for CC Bill Required
Please Select one DEPOSIT ONLY FULL FEE REMAINING BALANCE Required	I hereby authorize billing in the amount of $650 full fee or $300deposit (U.S. dollars) to my credit card as provided below. Be sure to use the pull down menu to the left to let us know if you want us to bill for deposit , full fee or remaining balance at this time. Full fee is due no less than 2 weeks prior to workshop if you hold a place with a deposit. Review cancellation policy.

Tell Us What YOU want to get out of the seminar, questions you want answered, etc.
If your partner is willing please have them either add to your comments or send a separate e-mail, being sure to put the names and date of the workshop so I know who is who!

How did you find out about this workshop? Please Select one This Website Brochure or flyer Therapist Church or synagogue Friend or family member Co-worker or colleague Imago Relationships International Other Website (please list below) Search Engine Other

                                  Other Website Name:
                                Other Referral Source:

YOU MUST CLICK ON SEND TO REGISTER!

WAYS TO REGISTER:
If you are paying by MasterCard, Visa, or American Express, you can:

a) Register on-line
b) Print out the registration form and fax it to 407-740-7763
c) Call my office at 407-740-7763 (If I am in session, or out of the office, you can either leave all the information, or leave your name, number, and the best time for someone to call you back.)
d) Mail the form in to the address listed below.

If you are paying by check or money order:

Print out the registration form, or request a brochure with a registration form
and mail to: (Make checks payable to Dawn Lipthrott)

Dawn J. Lipthrott, LCSW
1177 Louisiana Ave. Ste. 109
Winter Park, FL 32789

DISCLAIMER  Disclaimer: Information, observations, and opinions are offered for general reference only and should not be misconstrued as counseling advice, diagnosis or psychotherapy. Base your treatment or decisions solely upon the recommendations of your your own psychotherapist, counselor or physician or your own choices. By using this site, you signify full acceptance of our Terms of Use.   

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