We look forward to seeing you at an upcoming couples workshop! Step 1 of 4 25% To register, please fill out all the steps of the form. If you have any trouble with the form or Paypal, please contact us.Select a Workshop*January 26-28 (Houston)February 16-18 (Houston)March 16-18 (Houston)April 13-15 (Houston)May 18-20 (Houston - Couples in Recovery)June 8-10 (Houston)July 13-15 (Houston)August 17-19 (Houston)September 14-16 (Houston)October 13-15 (Houston)November 9-11 (Houston)Nov 30-Dec 2 (Houston)IMPORTANT: Please note: registration is not made until all the steps are complete. Your Details Fill in your detailsName* First Last Phone (Home)*Phone (Work)Phone (Cell)Email* Address* Street Address Address Line 2 City ZIP Code IMPORTANT: Please note: registration is not made until all the steps are complete. Partner DetailsPartner Name* First Last Does your partner have the same home phone number as you?*YesNoPartner Phone (Home)*Partner Phone (Work)Partner Phone (Cell)Partner Email* Does Your Partner Have The Same Mailing Address as You?*YesNoPartner Address* Street Address Address Line 2 City ZIP Code How did you learn about us?GoogleOther Search Engine (Bing, Yahoo, etc.)YelpFacebook AdOther Social MediaPublic LectureReferral (Please specify who referred you below!)Other (Please specify)Whom may we thank for their recommendation of the Imago Couples Workshop to you?IMPORTANT: Please note: registration is not made until all the steps are complete. I have read and agree to the Refundability Agreement:* Yes (Click Here to Read Refundability Agreement)Please Choose to Pay Either the Full Registration Fee, or Deposit.*$800.00 - Registration Fee$400.00 - Deposit (balance must be paid by 2 weeks prior to Workshop)Total $0.00 Please choose a payment option:*Pay by Check - Greatly PreferredPay with Credit Card Using PaypalIf your desire is to pay by check, simply mail your check asap (must be postmarked within 24 hours of your Registration.). Payable to: Damian Duplechain LPC, Inc. 5959 West Loop 610 South, Suite 600, Bellaire, TX 77401. Make it in order to continue to hold your Workshop slot. NOTE: Total fee balance is due no later than 14 days before the Workshop, i.e., before 6:30 pm on the 2nd Friday before your Workshop weekend. NOTE: Registration confirmation will be emailed within 24 business hours, containing venue directions, instructions, suggestions, and hotel discount information. Note also that it's not required to spend the night at the hotel, only a recommendation. Upon receipt of your registration confirmation, please immediately reply to confirm you have indeed received it. This iframe contains the logic required to handle Ajax powered Gravity Forms.