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Divorce Education Program Registration Form Space is limited, pre-registration is required. The cost is $80.00 per person. You can use this form to register using a Visa or MasterCard. You will receive a confirmation in 5-7 business days or sooner. If you do not receive a confirmation a week before the workshop please call Carol at 781-551-0999 ext. 224. If you would prefer to register by phone, fax or mail, please click here. Note: Our program is presented in Dedham or Norwood in alternating months. Be sure to be aware of which program you are signing up for.
Name of parent registering
Name on Card
Visa / MasterCard No.
Expiration Date	03/2003 format please
Address:
City:
State:
Zip:
Home Phone:
Work Phone:
E-mail Address:
Fax Number:
Name of other parent:
Dates of Seminar:
	REGISTRATION WILL BE CONFIRMED BY MAIL IF TIME PERMITS. OTHERWISE YOU WILL BE CONTACTED BY PHONE OR EMAIL. IF YOU HAVE NOT RECEIVED CONFIRMATION A WEEK IN ADVANCE OF THE PROGRAM PLEASE CONTACT CAROL AT CMANISCALCO@CFPSYCH.ORG OR 781-551-0999 X224.