Online Registration Form & Payment

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.

Payment Information:<div><div>This is a Professional Communication and Problem-Solving Workshop and may be reimbursed by your employer or union. Some companies reimburse their employees for these valuable personal-development training classes. Check with your union or employer.</div><div>
</div><div>Workshop Fee: $169 Per Couple for 2-Day 
> "Passage to Intimacy" Workshop</div><div>This includes two full days of powerful, interactive relationship education and practice sessions, Official PAIRS Manual and all materials and supplies.<o:p> </o:p> 
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<o:p>Note: 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.</o:p>

<o:p>How to make your payment</o:p>

<o:p>Forward your full payment in the form of a</o:p>

<o:p></o:p><o:p> check or money order payable to </o:p><o:p></o:p><o:p>"Heart to Heart Workshops" to:</o:p> 

<o:p>Heart to Heart Workshops</o:p>

<o:p></o:p><o:p>53 Kalla Lane</o:p>

<o:p>East Aurora, NY 14052</o:p></div>