Christian Marriages in Crisis

Workshop Registration

Your Name*
First Last
Address*
Street Address City State ZIP Code
Phone*
Email*
Select Your Workshop(s)
Please select the workshop(s) for which you want to register.
Workshop Selection
- Men's Workshop
- Women's Workshop
- Couple's Workshop
Men's Workshop Registration
Date of Men's Workshop You Are Registering For:*
MM slash DD slash YYYY
Is this registration for you or your spouse?*
- Me
- My Spouse
Spouse's Name*
First Last
Women's Workshop Registration
Date of Women's Workshop You Are Registering For:*
MM slash DD slash YYYY
Is this registration for you or your spouse?*
- Me
- My Spouse
Spouse's Name*
First Last
Couple's Workshop Registration
Important Note:
Before a couple can come to the CMIC Couples Workshop, each spouse must have attended his and her own individual (mens or womens) workshop. This assures us that both spouses have recieved the same foundational information and that each spouse has begun his/her individual recovery before addressing issues in their coupleship.
Date of Men's Workshop Attended*

Month and Year
Date of Women's Workshop Attended*

Month and Year
Spouse's Name*
First Last
Date of Couple's Workshop You Are Registering For:*
MM slash DD slash YYYY
Payment Information
Total
$0.00
How do you want to pay for the workshop(s)?
- Pay online in full using PayPal
- Send a check by mail
Pay Now in Full Using PayPal
Product Name
Total
$0.00
Send a Check by Mail
Deposit Amount*
Please make your checks payable to CMIC and be sure to designate them to the ministry of Paul and Suzanne Talley. Send your check for the "Total" amount above to:
CMIC
119 Hilltop Business Center Drive
Pelham, AL 35124

205-637-5242
info@christianmarriagesincrisis.com
www.christianmarriagesincrisis.com
IMPORTANT: The deposit for Mens and Womens Workshops is $300. Please enter at least this amount in the "Deposit Amount" box above. You may enter more than this amount.

When you complete this form, you will be taken to PayPal to complete the transaction for your deposit. PayPal accepts all major credit cards and you do not need a PayPal account to pay.

Please make your checks payable to CMIC. Send your check for the cost of the seminar ($675) minus the deposit amount you are paying today to:
CMIC
119 Hilltop Business Center Drive
Pelham, AL 35124

205-637-5242
info@christianmarriagesincrisis.com
www.christianmarriagesincrisis.com
IMPORTANT: The deposit for the Couples Workshop is $600. Please enter at least this amount in the "Deposit Amount" box above. You may enter more than this amount.

When you complete this form, you will be taken to PayPal to complete the transaction for your deposit. PayPal accepts all major credit cards and you do not need a PayPal account to pay.

Please make your checks payable to CMIC. Send your check for the cost of the seminar ($1300) minus the deposit amount you are paying today to:
CMIC
119 Hilltop Business Center Drive
Pelham, AL 35124

205-637-5242
info@christianmarriagesincrisis.com
www.christianmarriagesincrisis.com
Comments
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