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	Empowering families to create more joy, peace, and understanding.

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To Register for Classes...

Please fill out the form below and choose one of the two payment options.
(the information you provide to us is confidential and will not be shared with any third parties)

“The most precious gift we can offer others is our presence. When mindfulness embraces those we love, they will bloom like flowers.” -Thich Nhat Hahn


	Your Full Name:

		Partner’s Name (if taking class)

	Preferred Class Date:


	(required)


	Home Phone:

		Other Phone:

Mailing Address w/ Zip:

		Email Address:


	(required)

		(required)

Children:

Name:

Age:

Name:

Age:

Name:

Age:


		How did you hear about our classes?



		What would you like to gain from taking this class or workshop?



	Please indicate anything else you would like us to know:

Payment Options...

1. By Mail.

   Family InSight
   c/o Carlene Townley
   5308 Texas Blue Bell Dr.
   Spicewood, TX 78669

2. Pay with Paypal.

Paypal.com is an easy and secure way to send money over the internet.

Email us at carlene@familyinsight.com for directions on using this payment method. There is an $5 service fee for using this service.

Policies & Procedures...

Your spot is reserved with your full payment.
All courses are educational; and as such, are not intended to be a substitute for family counseling or psychotherapy.
Personal matters may be discussed during these classes and I agree to keep such matters confidential.


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