Menopause/Perimenopause Support Group Registration Form

Menopause/Perimenopause Support Group Registration Form

Register for the November–December sessions and pay $100 upfront, with the remaining $100 due at your second meeting.
Full Name

First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
How did you find out about this group?
Is there anything you'd like the facilitator to know?
Session Schedule
All meetings are at 6:30 pm:
- Tuesday, November 17
- Tuesday, November 24
- Wednesday, December 2
- Tuesday, December 8
Total fee is $200 for all 4 sessions. $100 is due at registration, and the remaining $100 is due by the second group meeting.

Therapy Group Series (4 sessions)

Includes all 4 group sessions. $100 is required now to secure your spot. The remaining $100 is due by the second group meeting.

$200.00

Total