Registration
REGISTRATION for "Getting the Love You Want" or "Keeping the Love You Find" Workshop (please circle one)
Name(s)_______________________________________________
Address___________________________________________________________________________________________________
Phone numbers_________________________________________
e-mail address________________________________________
Preparing for marriage? ______ Never married ?____________
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 ? _____________
Have you read "Keeping the Love You Find"? ______________
Enclosing a deposit of 200NIS for the workshop._______
Send to:
Charlotte Slopak Goller, Ph.D.
6 Miriam HaHashmonait
93558 Jerusalem
Phone: 0544-745369 (NS)
e-mail: charlots@netvision.net.il