Tuition: Total cost of course $495.00 this requires a $100 Deposit. (Balance due before the weekend.) Redirect Your Life For Singles Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Your Goals for the Singles Adventure CourseWhat type of romantic relationship would you like?What would you like to gain from attending the Singles Adventure?Additional InformationDescribe the relationship between your parents.How did you find out about sex and what are your current beliefs about sex?What was the duration of your last 4 relationships? Please List as 1.,2.,3.,4.What is your greatest challenge in seeking, finding and maintaining a relationship?In your last 2 relationships how did you meet? How did the relationship end?MetEndedMetEndedPrint or type four of your early recollections. It does not matter how old you were as long as the memory is the earliest experience you remember that meets the stated requirement of the recollection. An early recollection describes a specific one-day event. Examples: Example #1 age 7. One day I was riding my bike on the street and my brother yelled at me to stop. I felt scared. Example #1 qualifies as an Early Recollection because it describes an actual event. Example #2 “My brother and I used to ride our bikes on the street.” Example #2 does NOT qualify as an Early Recollection because it describes something that happened often and does not give the details of specifically what occurred on one day. It is also missing the age and how he felt.Early Recollection 1 Age & IncidentI FeltEarly Recollection 2 Age & IncidentI FeltEarly Recollection 3 Age & IncidentI FeltEarly Recollection 4 Age & IncidentI FeltVision InformationDescribe your ideal relationshipList the past hurts you have from previous relationships, including the relationship with your parents 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 have read and understand this entire agreement and agree to these terms and conditions above.* Agree Redirect Your Life For Singles*DepositPay in FullMade ArrangementsCommentsThis field is for validation purposes and should be left unchanged.