PRIVATE APPOINTMENT WITH GEORGE ANDERSON--PRINTABLE REGISTRATION FORM
Please fill out this form and mail it to us with your payment/deposit to the address below. Processing usually takes 2 weeks. A confirmation letter will be sent via return mail indicating the date, time and location of your session. Payment may be made by check or money order. (U.S. funds only.) For international registrants, we can only accept International Postal money orders or checks made in U.S. funds from a U.S. Bank
Cost per
session:
(children under the age of 16 may attend with a parent/guardian at
no charge)
1-2 persons 1200.00
3 persons 1700.00
Family 2000.00
(Up to 6 immediate family members, making contact with the SAME
family member )
Deposits For
those who wish to hold an appointment and send the balance of funds over time,
we will gladly accept a deposit for 50% of the session fee, provided the
balance is paid in full by no later than 15 days before the scheduled program
date. Upon your initial deposit we will reserve a spot for you in your program
of choice, and send you an acknowledgement of your deposit, the date, the time
and the location of your appointment. When the balance of funds is paid in full
we will issue your confirmation letter which you will need to bring with you to
the session.
Refunds You have until 24 hours before your
appointment to receive a full refund of your session fee or deposit. We
regret that after the date of your scheduled session, the registration
fee/deposit is non-refundable. As long as we are notified by the day before your
scheduled appointment, we will be happy to refund your full session fee.
By filling out the form below, you acknowledge that you understand and accept
the terms herein.
PLEASE ALLOW 3 WEEKS FOR YOUR REGISTRATION TO PROCESS AND RECEIVE YOUR
CONFIRMATION
---------------------------------------------------please
detach and send with your payment-------------------------------------------------
George Anderson Grief Support --PRIVATE SESSION Registration Form
Enclosed, please find my
_______ deposit ______payment in full for
___ persons for a private session on:
____TUESDAY, APRIL
24 ____WEDNESDAY, APRIL 25 ____THURSDAY, APRIL 26, 2012
appointment times are 3PM, 4PM, 5PM and 6PM. Please circle one of
these times if you have a preference.
If the date I requested is full at the time you receive my request, please:
(check one)
_______PLACE ME IN THE SOONEST
AVAILABLE DATE _______CANCEL MY REGISTRATION AND RETURN
MY FUNDS
I have made my check/money order in US
FUNDS payable to:
George Anderson Grief Support Post Office Box 733 Deer
Park, New York 11729
Please send or email* my confirmation letter to: (please PRINT)
Name:
_____________________________________________________________________________________
Address:___________________________________________________________________________________
City:______________________________________State_________Zip
Code____________________________
Contact number: (required)_________________________ *I
wish to have my confirmation sent via email: (please print
clearly)_____________________________________