Register

Registration: All responses are confidential

First Name

Last Name

Phone

Please tell us the best number to reach you.

Address

Apt, suite, etc.

Country

City

State

Zip code

Choose workshop type:

Two Day Workshop For Personal Change

Informational Evening

9-Week Process For Personal Change

Date(s) for which you are registering

Current therapist, if any:

Number of people planning to attend:

Dietary limitations we should know about?

Workshop Contract

Please download the PDF of Workshop Contract, print, fill-in info, and send in mail with $300 for a two-day Workshop.

Process Contract & Cost Sheet

Please download the PDF of Client Contract and Cost Sheet, print, fill-in info, and send in mail with $500 deposit.

How did you hear about us?

When you have registered we will send you detailed location information.

If you have any questions filling out this request, please call Elaine Baskin at 650.494.0255.

We will be in touch soon!

We never distribute our mailing list to anyone.

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