REGISTER Register 1 Your Information2 Emergency3 Health4 Client Insight Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Year and Month of Birth*Workshop You Would Like to Register For*Path to Healing Empowerment WorkshopRecovery and Empowerment GroupsI Did Not See That ComingWorkshop Fee: $1750 Deposit to hold your spot is $300 We Will Call You For A Credit Card PaymentFee: $60 per session Must Commit to full series of 12 sessions $60 discount if paid in full prior to first session We Will Call You For A Credit Card PaymentPlease Choose A DateJune 24-26, 2020July 23-25, 2020Aug 20-22, 2020Sept 23-25, 2020Oct 22-24, 2020Please Choose Preferred Day & TimeTuesday 6:00pm – 7:30pmThursday 10:00am – 11:30amChoose WorkshopVirtual Workshops CoachingIntensive WorkshopsInvestment: Path CoachingPath Coaching + Intensive Package:Monthly Virtual Group Coaching Session8 Online Sessions via ZOOM Wednesdays 7:00pm – 8:30pm ESTHeld at The Path to Healing in Delray $520.00 (8 group sessions @ 65 per session)Workshop Fee: $2270.00 In the event this office needs to contact you may we:* Leave a voice mail Send email Send letter Send text Emergency Contact First Last PhoneRelationship Are there any medical conditions for which you receive treatment?*Are you currently feeling suicidal or having a desire to self harm?*Have You ever attempted suicide before?*If so when and how was it resolved?Routine Medications and supplements:* What are your hopes for yourself at The Path to Healing?Who may we thank for referring you to The Path to Healing