REGISTRATION for "Getting the Love You Want" Workshop

 

 

Names _______________________________________________

 

Address___________________________________________________________________________________________________

 

Phone numbers_________________________________________

 

e-mail address________________________________________

 

Preparing for marriage? ______

Married___________ Together how long?__________________

Number of children__________________

 

Are you familiar with Dr. Harville Hendrix's Imago Relationship Therapy?___________________________________________

Have you read Getting the Love You Want ?  _____________

 

 

We are enclosing a deposit of 200NIS for the workshop._______

 

 

Send to:

Charlotte Slopak Goller, Ph.D.

Rehov Dan 20

93509   Jerusalem

 

Phone:  02 6739094 (NS)

e-mail: charlots@netvision.net.il