HOLD ME TIGHT ASHEVILLE
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Hold Me Tight Workshop
Registration Form
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Select Your Workshop Dates/Location
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March 28 - 29, 2020 Asheville, NC
Your Name
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First
Last
Your Email
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Phone Number
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Partner's Name
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First
Last
Partner's Email
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Address
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Line 1
Line 2
City
State
Zip Code
Country
Are you seeing a couples counselor? If so, who?
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How long have you and your partner been together?
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What do you hope to get out of attending?
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How did you hear about us?
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If you were referred by another provider, do we have your permission to thank them?
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Yes
No
Do you or your partner need parking near the door of the workshop due to physical health issues? This is relevant for the Asheville location.
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Yes
No
Regarding CEU or Certificate of Attendance for licensed clinicians, please select:
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None
Certificate of Completion, for self, no charge
Certificate of Completion, for partner, no charge
Intend to purchase CE credits from R. Cassidy Seminars for self
Intend to purchase CE credits for partner
Comments
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We understand that this is an educational workshop and is not meant to replace couples or individual therapy. We understand that we are fully and solely responsible for the results and decisions we make regarding the use of the content of this program. We release the facilitators, the program developer and all related institutions from any and all responsibility or promise and accept full responsibility for any change or decision now or ever made regarding our involvement in this program and use of any related materials.
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Agree
Disagree
SUBMIT
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