Getting the Love You Want Registration Form
Names_________________________________________________
Our nametags should read______________________________
Mailing Address_______________________________________
City__________________________________________________
State_________________________Zip_____________________
Home ( )________________Work ( )__________________
Fax ( )_________________Email_______________________
Referred by___________________________________________
Date of workshop______________________________________
Method of Payment
_ Check
_ Visa/MC/AmEx #______________________________________
Exp. Date__________________________
$ Amount__________________________
Card Signature________________________________________
Make checks payable to Beverly S. Talan, Ph.D.
and mail with this registration form to:
380 N. Old Woodward, Suite 156, Birmingham, MI 48009
Or Fax to: (248) 626-8089
Sign up Soon - Space is Limited!
WORKSHOP FEE: $700*
A deposit of $350 will reserve a place for you. The
balance of $350 is due one week before the workshop begins.
*Discount of $50 if you pay $650 in full three weeks before
the workshop begins.
The fee includes two workbooks and coffee/refreshments
breaks. Meals and accommodations not included.
If you have previously attended my workshop, or one by
another presenter, bring your own manuals and attend for
$350/couple. Add $120 for new manuals.
Cancellation Policy:
If you withdraw 8 days or more prior to the start date
of the workshop, your fee will be refunded, less a $100
administration fee. For withdrawals made 7 days or less period to the start of the workshop, your fee is non-refundable but can be transferred to the next workshop.