Couples Registration

Step 1 of 3

About
The Couples Course is for couples (married or not) who are committed to each other and to the growth of their relationship.
Registering for the following session:*
Tuition

All prices listed are in USD. Your tuition will include the cost of food and a suite to stay in over the weekend.

When completing a Couples application, you will have your choice of:
- A non-refundable, non-transferable deposit of $400.
- Pay your full tuition.
If only a deposit is paid, you will be put on a monthly payment plan to have the Couples course paid in full 2 weeks prior to the start of the class.

Changing of class dates from your initial application date choice may result in a $400 Pathways administrative change fee.
Tuition Option*

Save and Continue Later

Personal #1
Student Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone
Work Phone*
Cell Phone*
Email*
Sex*
Preferred Pronouns
Birthdate*
Why do you want to attend the Couples Course?*
Personal #2
Student Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone
Work Phone*
Cell Phone*
Email*
Sex*
Preferred Pronouns
Birthdate*

Save and Continue Later

Payment Information
Discount Code
Total
$0.00
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*

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Billing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
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*
MM slash DD slash YYYY
Refund Policy
Upon acceptance into the Pathways Couples 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 have originally scheduled there will be a $200 transfer fee.
I acknowledge that I have read, understand and agree to all of the above terms and conditions of the Refund Policy.
Name*
Date*
MM slash DD slash YYYY
Name
This field is for validation purposes and should be left unchanged.

Save and Continue Later

Couples Registration

Step 1 of 3

About

Tuition

Personal #1

Personal #2

Payment Information

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.

Refund Policy

I acknowledge that I have read, understand and agree to all of the above terms and conditions of the Refund Policy.