Workshop Registration:

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Partner Name
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Select Workshop




The regular workshop fee is $695 per couple. If you register 3 or more weeks in advance of the workshop, you receive a $50 early bird discount. You may hold your place with a deposit of $350 if you wish.

The fee includes the workshop program, workbooks and refreshments. Hotel and meals are not included (we do get a discount for the hotel.)

PRIVATE WORKSHOPS:
The private workshop fee is $1500.
You may hold your place with a deposit of $700 if you prefer.

Cancellation:
If you cancel 15 or more days in advance of the workshop, you will receive a full refund. If you cancel 14 days or less before the workshop, you will receive a refund minus a $150 administrative fee which may be applied to a workshop within 1 year.

Payment Information (Visa, MasterCard or Amex)

You may enter your payment details here through our secure server for full fee or deposit.

Credit Card Number:


3 digit code on back or 4 digit code on front of Amex
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Expiration date: (XX / XXXX)
                    


Cardholder Name:
                  


Zip Code for credit card billing address:
                    


I hereby authorize billing in the amount indicated in the pull-down menu above. I understand that if Dawn Lipthrott, LCSW bills for the deposit, the remainder will be billed the week of the workshop.

How did you find out about the workshop? (Check all that apply)




Other: Please specify below:

I will send you goals forms before the workshop, but if you have any specific questions or comments, please include them below:

Questions or Comments:

Use of this form or website does not constitute the establishment of a counselor-client relationship between Dawn Lipthrott and a user and does not obligate Dawn Lipthrott to follow-up, contact, or accept as a client any users of this Web site. If you are experiencing any emotional or personal problem or are considering making decisions for your life, marriage or other relationship, and are seeking advice, you should base any and all decisions on the judgment and advice of your personal counselor or physician who has evaluated you face-to-face.

Contact Info

Dawn Lipthrott, LCSW.
c/o The Relationship Learning Ctr.
1177 Louisiana Ave. Ste. 109
Winter Park, FL 32789

Telephone: 407.740.7763