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Online Registration Form & Payment

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LEARN THE TOOLS FOR A HAPPY LIFE
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Registration Form & Payment Information

Please Fill Out the Registration Form completely and submit along with your payment to hold your seats at the Workshop of your choice.

Hosting a PAIRS Training for your church or organizaiton.

Note: It is our policy to NEVER share your personal information with any other entity. It is for the sole use of Heart to Heart Workshops.
 
Registration Form / Gift Certificate Form
1. To register yourself: Fill out the form below with your information and type the workshop dates you are requesting in the comment section.
2. To request a Gift Certificate: Fill out the form using the  couple's names and address who will be receiving the certificate. Then, type in YOUR name, address and phone in the Comment Section and state if you want the certificate sent to you or directly to the other party. Forward the full amount for the workshop by check or money order made out to "Heart to Heart Workshops". As soon as your payment is recorded, the Gift Certificate will be sent out. The certificate is good for one full year from it's issue date.  

My Own Registration
Gift Certificate for Another Person
Your First Name - or - Name to go on Gift Certificate
Your Last Name
Partner's First Name - or - Name to go on Gift Certificate
Partner's Last Name
Street Address
City
State
Zip Code
Home Phone Number
Cell Phone Number
E-Mail Address
COMMENT SECTION: Workshop Name & Dates Requested. NOTE: If you are requesting a Gift Certificate then place YOUR FULL NAME, ADDRESS AND PHONE IN COMMENT SECTION. Also indicate if you want the certificate sent to you or directly to the people on the above registration form. Please be sure to enter their correct names and address on the above form.
  

<font face="Times New Roman,Times,serif" size="7"><b style="mso-bidi-font-weight: normal;"><font face="Times New Roman"><font size="5">Payment Information:</font></font></b><div><div><strong><font size="4">This is a Professional Communication and Problem-Solving Workshop and may be reimbursed by your employer or union. <u>Some companies reimburse their employees for these valuable personal-development training classes. Check with your union or employer.</u></font></strong></div><div><font face="Arial,Helvetica,sans-serif"><font size="4"><strong>
</strong></font></font></div><div><font face="Arial,Helvetica,sans-serif"><font size="4"><strong>Workshop Fee:</strong> <u><strong>$169 Per Couple </strong></u></font></font><font face="Arial,Helvetica,sans-serif"><font size="4"><strong><u>for 2-Day </u></strong></font></font>
><font face="Arial,Helvetica,sans-serif"><font size="4"><strong> <u>"Passage to Intimacy" Workshop</u></strong></font></font></div><div><font face="Arial,Helvetica,sans-serif"><font size="4">This includes two full days of powerful, interactive relationship education and practice sessions, <strong>Official </strong></font></font><font face="Arial,Helvetica,sans-serif"><font size="4"><strong>PAIRS Manual</strong> and all materials and supplies.</font></font><b style="mso-bidi-font-weight: normal;"><!--?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" ?--><o:p>&nbsp;</o:p></b><b style="mso-bidi-font-weight: normal;"><font face="Arial,Helvetica,sans-serif">&nbsp;</font></b>
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</font></o:p></b></p><p class="MsoNormal" style="margin: 0in 0in 0pt;"><b style="mso-bidi-font-weight: normal;"><o:p><font face="Arial" size="4"></font></o:p></b>
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<p class="MsoNormal" style="margin: 0in 0in 0pt;"><o:p><font face="Arial,Helvetica,sans-serif"><font size="4"><u><strong>Note:</strong></u> Heart to Heart Workshops reserves the right to cancel any workshop or to change the location of the workshop. Fees for cancelled workshops will be refunded in full or applied to another workshop at the discretion of the participant.</font></font></o:p>
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<p class="MsoNormal" style="margin: 0in 0in 0pt;"><b style="mso-bidi-font-weight: normal;"><o:p><font face="Arial,Helvetica,sans-serif"><font size="4"><u>How to make your payment</u></font></font></o:p></b>
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<p align="center" class="MsoNormal" style="margin: 0in 0in 0pt;"><o:p><font face="Arial,Helvetica,sans-serif" size="4">Forward your full payment in the form of&nbsp;a</font></o:p>
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<p align="center" class="MsoNormal" style="margin: 0in 0in 0pt;"><o:p></o:p><o:p><font face="Arial,Helvetica,sans-serif" size="4">&nbsp;<strong>check</strong> or <strong>money order</strong> payable to </font></o:p></p><p align="center" class="MsoNormal" style="margin: 0in 0in 0pt;"><o:p></o:p><o:p><font face="Arial,Helvetica,sans-serif" size="4"><strong>"Heart to Heart Workshops" to:</strong></font></o:p>&nbsp;
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<p align="center" class="MsoNormal" style="margin: 0in 0in 0pt;"><b style="mso-bidi-font-weight: normal;"><o:p><font face="Arial,Helvetica,sans-serif" size="4">Heart to Heart Workshops</font></o:p></b>
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<p align="center" class="MsoNormal" style="margin: 0in 0in 0pt;"><b style="mso-bidi-font-weight: normal;"><o:p></o:p></b><b style="mso-bidi-font-weight: normal;"><o:p><font face="Arial,Helvetica,sans-serif" size="4">53 Kalla Lane</font></o:p></b>
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<p align="center" class="MsoNormal" style="margin: 0in 0in 0pt;"><b style="mso-bidi-font-weight: normal;"><o:p><font face="Arial,Helvetica,sans-serif" size="4">East Aurora, NY 14052</font></o:p></b></p></div></font>