Contact Us
office@pathwaysseminars.com
(847) 478-1088
About
About Pathways Courses
Frequently Asked Questions
Success Stories
Courses
Virtual Programs
Basic
Advanced
Leadership
Couples
Business Training
Coaching
Videos
Calendar
Contact
Free Webinar
Enroll
FREE WEBINAR
ENROLL
Fax: (847) 478-1755
email
Advanced Registration
Step 1 of 5
20%
Registering for the following weekend:
*
Please select a weekend
CURRENTLY NO SCHEDULED DATES
I am a...
*
Please select student status
New Student (Adult)
Repeat Student (Adult)
New Student (Minor)
Repeat Student (Minor)
Personal Details
Student Name
*
First
Last
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Swaziland)
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Réunion
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Home Phone
Work Phone
*
Cell Phone
*
Marital Status
*
Please identify marital status
Single
Married
Divorced
Widowed
Sex
*
Please select
Male
Female
Other
Birthdate
*
Email
*
Why do you want to attend the Advanced Course?
*
Business Details
Occupation
*
Title
*
Company Name
*
Company Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Family Details
Spouse's Name
First
Last
Spouse's Birthdate
Spouse's Sex
Please select
Male
Female
Other
Child's Name
Child's Birthdate
Child's Sex
Please select
Male
Female
Other
Child's Name
Child's Birthdate
Child's Sex
Please select
Male
Female
Other
Child's Name
Child's Birthdate
Child's Sex
Please select
Male
Female
Other
Who shared the course with you? (Sponsor)
Sponsor Name
*
First
Last
Emergency Contacts
Emergency Contact Name
*
First
Last
Emergency Contact Phone
*
Emergency Contact Relation
*
Emergency Contact Name
*
First
Last
Emergency Contact Phone
*
Emergency Contact Relation
*
Repeating Students Only
Date first attended Basic
MM
DD
YYYY
Date first attended Advanced
MM
DD
YYYY
Who will be attending with you?
First Name
Last Name
Fore Minor's Guardian Only
Minor's Name
First Name
Last Name
Full Name of Parent or Guardian
First Name
Last Name
Your relationship to the minor
Minor Guardian Waiver
By filling in my name and date below, I, as parent or legal guardian of the minor named below, in such capacity, do hereby authorize the enrollment of the minor for the Pathways to Successful Living Advanced Course. I further certify that all of the responses in the minor's Advanced Course Application, are accurate and complete and that the minor does not have nor has ever had any mental disorders, epilepsy, fainting spells or other emotional, psychological or psychiatric symptoms, diseases or illnesses and that the minor is not currently undergoing nor has had treatment for any of the foregoing.
Address (if different from the minor)
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Name
*
Date
*
Date Format: MM slash DD slash YYYY
Tuition
All prices listed are in USD.
Advanced Tuition
We have included an Advanced / Leadership package. This package includes the price for Advanced and Leadership along with lodging for the Advanced Course. Packaging prices must be paid in full. Meals are not included for either course. This package gives you a savings of $500. The price for Advanced Course alone includes lodging and tuition; however, meals are not included and must be purchased by the participant. A non-refundable, non-transferable deposit of $200 must accompany your application and must be used within one year of submitting this application. If you are not paying in full, you will be put on a payment plan for the balance of your tuition which must be paid in full two weeks prior to your attendance of the Advanced Course. I agree that my monthly payments will be charged automatically on either the 5th or 20th. I understand that if my balance is not paid in full by two weeks before the first day of my course, I will lose any discount I may have received.; I understand that if I am submitting this application less than two weeks before the first day of the course, I am not eligible for a discount.
Non-Refundable Registration Fee:
A non-refundable registration fee of $200.00 USD or full payment must accompany this application to reserve your place in the class, and must be used within one year of submitting this application. If you choose to change the date from the one you originally scheduled, there will be a $200 transfer fee. For a second move there will be a $300 transfer fee to cover costs. The balance of your tuition must be received no later than two (2) weeks prior to your attendance. Only one discount can be applied at a time. The Facilitator may terminate the participation of any participant whose conduct is disruptive or inconsistent with the purpose of the course.
Tuition Option
*
Please select an option
$200 (Deposit)
$1995 (Full Payment)
$1295 - (Young Adult / Repeat)
Payment Information
Credit Card Charges
*
By posting this electronic form with the following credit card information, I authorize Paige, Martin & Associates, Inc. to charge my credit card account.
Credit Card Number
*
Cardholder Name
*
Credit Card Expiration Date
*
CVV Code
*
Card Holder Zip Code
*
Terms and Conditions
*
Please read carefully and check each box of the agreement.
By checking this box, I agree that my remaining balance will be charged to my credit card two weeks before the first day of my course, unless I call the office to arrange another payment plan.
I understand that if my balance is not paid in full by two weeks before the first day of my course, I will lose any discount I may have received.
I understand that if I am submitting this application less than two weeks before the first day of the course, I am not eligible for a discount.
By filling in my name and date below, I acknowledge that I have read, understand and agree to all of the above terms and conditions.
Name
*
Date
*
Date Format: MM slash DD slash YYYY
Refund Policy
Upon acceptance into the Pathways Advanced Course, it is my understanding that there will be no refund of any part of my tuition. If you choose to change the date from the one you originally scheduled there will be a $200 transfer fee. For a second move there will be a $300 transfer fee to cover costs. The Facilitator may terminate the participation of any participant whose conduct is disruptive or inconsistent with the purpose of the course.
I acknowledge that I have read, understand and agree to all of the above terms and conditions of the Refund Policy.
Name
*
Date
*
Date Format: MM slash DD slash YYYY
Medical and Psychological Information.
Due to the participatory nature of the course, the following information is required to attend. This is done in order to provide the best learning environment possible for you and the other participants. Please answer the following questions by checking the appropriate response. Your answers are kept confidential except for possible disclosure to your physician, psychiatrist, psychologist or therapist, if applicable. If you have any questions or concerns regarding the following, please contact the Pathways office.
1. Have you any history of Psychiatric Disorder?
*
Yes
No
2. Have you ever been institutionalized for mental illness?
*
Yes
No
3. Are you now undergoing, or have you within the last one (1) year undergone treatment by a psychiatrist or psychologist for a psychiatric disorder or mental illness?
*
The Basic Course is based on an educational model, not a medical model. None of the Pathways staff are licensed psychiatrists or psychologists.
Yes
No
4. Do you have any physical symptoms, diseases, illnesses, or disabilities?
*
Yes
No
5. Have you been hospitalized for a physical injury within the last twelve (12) months?
*
Yes
No
6. Are you now undergoing, or have you within the past six (6) months undergone treatment by a medical doctor?
*
Yes
No
7. In case of emergency I give my consent to Pathways to disclose any part of my experience they deem necessary to get the medical attention I may need. Pathways has my permission to speak with paramedics, physicians, therapists, and psychiatrists or psychologists as applicable.
*
Yes
I have read and understand the above questions and by checking this button I certify that my answers are accurate and complete.
*
Yes, I understand the above questions and I certify that my answers are accurate and complete.
Name
This field is for validation purposes and should be left unchanged.
Menu