Redirect Your Life for Couples

Redirect Your Life Couples Form

Total cost of course $995 ($300 Deposit Required) includes all accommodations and meals.

Required *

Name *

Address *

City *

State *

Phone Number *

Home

Mobile

Work

Partners Name *

Address

City

State

Partners Phone Number *

A separate form must be completed and submitted by each partner.

Speak from your heart

When you fill this out remember that only you have your answers and no one else can tell you how you feel. Take a deep breath and listen to your heart.

1. What decisions did you make based on your childhood experiences regarding the following:

Men Are:

Women Are:

Relationships Are:

2. What have you learned about yourself from your previous love relationships that you are bringing to this relationship?

Details:

3. Why do you think you and your partner are in a relationship?

Details:

4. What do you love about your partner?

Details:

5. Name 3 qualities that you bring to your relationship:

Details:

6. What is your behavior when you do not feel close to your partner?

Details:

7. In what ways do you show love to your partner?

Details:

8. How do you receive love? When do you feel loved the most?

Details:

9. What are 3 areas in your relationship that you’d like to improve?

Details:

What will be your contribution?

10. Where do you envision your relationship in one year?

In 5 years?

In 10 years?

Total cost of course $895 ($300 Deposit Required) includes all accommodations and meals.

Payment Method * Check Credit Card

Credit Card Type Visa MC Discover Amex

Credit Card Number

Expiration Date

CVV Number

Billing Address *

Make checks payable and remit to:

MC Insights Inc. 16 Beech Drive, Maggie Valley, NC. 28751

I am aware that breaking the agreement would greatly minimize the value I would gain from the course, and therefore, I will be responsible for overcoming any circumstances which would prevent me from keeping this agreement.

I agree to attend, in their entirety, all sessions of the course.

I agree to be on time for each session.

I agree to return the Student Information Sheet and this signed Enrollment Agreement Form within 5 days.

I agree not to take any non-prescription drugs or alcohol within 24 hours of any session.

As a participant of this course, I agree to respect the confidentiality of all participants and their remarks.

Informed Consent Agreement

I understand that this course is educational and NOT psychotherapy or a substitute for psychotherapy.

I understand that in addition to the benefits, there is always the risk of emotional and/or medical contingencies in such a group experience. I assume the risk, by this consent, of any accident or injury to myself during this course, or inflicted by me during the course, and hereby release the instructors from any liability thereof.

I hereby authorize the instructors to take any reasonable steps on my behalf on the case of an accident, injury, or illness including, but not limited to, first aid, doctor, nurse and/or ambulance services, etc. I agree to be liable for the cost of any such actions taken on my behalf, and hereby release the instructors for any liability thereof.

If I have had serious emotional problems or have been hospitalized for emotional problems or am currently under the care of a psychologist or psychiatrist, I understand that it is required that I attend the program only with the written permission of my therapist.

Refund Policy
After the course, if you are dissatisfied, your tuition will be refunded provided all of the following conditions have been met:

You have been in attendance the full time for each of the sessions of the course.

You have participated in all the exercises of the course.

You have met with the instructors.

You have submitted a request for a refund, stating the reasons for your dissatisfaction, within seven days of the last session of your course.

I have read and understand this entire agreement and agree to these terms and conditions above.

I have read and understand this entire agreement and agree to these terms and conditions above. *

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