Completion of this registration form, submitted with your payment, will confirm your spot in the workshop and / or will initiate couples session appointments. The fee for the workshop is non-refundable after the registration deadline has passed.

    Partner One Information

    Partner #1: Legal Sex
    MaleFemale

    Partner #1: Race-Check all that apply

    Partner #1: Ethnicity-Check all that apply

    Partner #1: First Marriage
    YesNo

    Partner #1: Children
    YesNo

    Partner #1: Have you been a NCC client before?
    YesNo

    (Optional but helpful):

    Partner Two Information

    Partner #2: Legal Sex
    MaleFemale

    Partner #2: Race-Check all that apply

    Partner #2: Ethnicity-Check all that apply

    Partner #2: First Marriage
    YesNo

    Partner #2: Children
    YesNo

    Partner #2: Have you been a NCC client before?
    YesNo

    (Optional but helpful):

    General Information


     

    Press send to submit this form. After receiving your registration, we will be in contact with you.
    Thank you!