Course Registration Form

* indicates required information.

Please provide the following enrollment information:

*Name

Spouse

*Credit Card Billing Information

Street Address

Address (cont.)

City

State/Province

Zip/Postal Code

Country

Work Phone

Home Phone

FAX

*E-mail Address

Spouse E-mail

Please check the box for your course selection:

Women's Courses

G-Spot Workshop: July 11, 2015 Bakersfield, CA (N); $150 per person

Couples' Courses

TBA

Private Programs

Libido Enhancement Private Program: $450

Beloveds, Private Program for Couples: $3000

Sacred Sexuality, Private Program for Women: $3000

G-Spot, Private Program for Individuals or Couples: $750

Men's Course, Private Program for Men: $2,225

We will contact you to arrange scheduling for Private Programs upon receipt of payment.

Telephone Sessions

Get Started: 4 30-minute sessions: $195

1 hour phone session: $150

½ hour phone session: $75

We will contact you to arrange scheduling for Telephone Sessions upon receipt of payment.

Please provide the following ordering information:

Credit Card:

*Cardholder Name

*Card Number

Security code from back of card:

*CVV Number

*Expiration Date

Total $ Amount

Please add any comments or questions:

If you prefer you can print out this form and mail it to the Women's Sexuality Center.

Cancellation Policy

Deposit is nonrefundable. If you cancel 2 weeks or more prior to workshop start date, your cancellation fee is $100 per person. If you cancel less than 2 weeks prior, your fee is nonrefundable. Your credit card will automatically be billed 30 days prior to workshop start date. No refunds on private programs.

I have read the cancellation policy and I agree to its terms and conditions.

Form is submitted using a secure server.

For more information please call or email us!

Women's Sexuality Center
TEL: 805.729.2590