Boot Camp for Couples
Time to get your relationship in shape
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Classes to be held in Delray Beach, Florida
Congratulations! If you’re on this page, you’ve decided to stop thinking and talking about getting you relationship in shape and are taking some action. Ready, set, GO!
REGISTRATION FORM
Date: ___________ How did you hear about Boot Camp for Couples? ____________________
Name 1: ______________________________ DOB: ___________ Sex: M F O
Address: ___________________________ City: _____________ St: ___ Zip: _______
Phone: (Home) ______________ (Cell) ________________ Email: _____________________
Birth Date: ____________ Occupation: _____________________ Marital Status: S M D W
Number of years married/together: ___________ Number of Children: _________
Name 2: ______________________________ DOB: ___________ Sex: M F O
Address: ___________________________ City: _____________ St: ___ Zip: _______
Birth Date: ____________ Occupation: _____________________ Marital Status: S M D W
Number of years married/together: ___________ Number of Children: _________
Select which level, session, or class(es) you will be attending from the list below.
Register for Level 1, Level 2, or Level 3, and receive a discount of $200 from cost if classes and consultations with Dr. Amy were purchased separately.
Register for Level 1 and Level 2, and receive a discount of $500 from cost if classes and consultations with Dr. Amy were purchased separately.
Select which Level, Session or individual class(es) you will be attending
___ Level 1: Basic Training: $1,025
Price includes two hours of *private consultation plus four weeks of Boot Camp. Select to
save $200 off cost if services were purchased separately.
___ Session A: Boot Camp meets on Saturday from 9:00am-11:00am
If you are not attending Level 1, select class(es) from the list below. Cost per class: $250. If you select two or more classes, cost reduced to $225 per class.
___ Basic Skills: June 15, 2013
___ Strengthen your Voice: June 22, 2013
___ Pucker Up: June 29, 2013
___ Muscle through the Tough Times: July 6, 2013
___ Session B: Boot Camp meets on Saturday from 1:00pm-3:00pm
If you are not attending Level 1, select class(es) from the list below. Cost per class: $250. If you select two or more classes, cost reduced to $225 per class.
___ Basic Skills: July 20, 2013
___ Strengthen your Voice: July 27, 2013
___ Pucker Up: August 3, 2013
___ Muscle through the Tough Times: August 10, 2013
*Couple consultation to be scheduled with Dr. Amy; one prior to and one after the Boot Camp.
___ Level 2: Interval Training: $1,025
Price includes two hours of *private consultation plus four weeks of Boot Camp. Select to save $200 off cost if services were purchased separately.
___ Session A: Boot Camp meets on Saturday from 1:00pm-3:00pm
If you are not attending Level 2, select class(es) from the list below. Cost per class: $250. If you select two or more classes, cost reduced to $225 per class.
___ Tag Team: June 15, 2013
___ Jumping through Hoops: June 22, 2013
___ Archery: June 29, 2013
___ Running the Marathon: July 6, 2013
___ Session B: Boot Camp meets on Saturday from 9:00am-11:00pm
If you are not attending Level 2, select class(es) from the list below. Cost per class: $250. If you select two or more classes, cost reduced to $225 per class.
___ Tag Team: July 20, 2013
___ Jumping through Hoops: July 27, 2013
___ Archery: August 3, 2013
___ Running the Marathon: August 10, 2013
*Couple consultation to be scheduled with Dr. Amy; one prior to and one after the Boot Camp.
___ Level 3: Intensive Training: $1,350
Cost includes three hours of *private consultation plus nine hours of Boot Camp. Due to the accelerated pace of this class, individual classes not offered. If these services were purchased separately, cost would be $1,525.
___ Session A
Day: Sunday; June 16, 30, July 14, 2013
Time: 1:00pm-4:00pm
___ Session B
Day: Sunday; July 14, 28, August 11, 2013
Time: 9:00pm-12:00pm
*Couple consultation to be scheduled with Dr. Amy; one prior to, one following week 2, and one after the Boot Camp.
___ I want to save $500 and registered for Level 1 and Level 2
TOTAL: ______
Proceed to check out.
Click here to schedule a private session with Dr. Amy.
Thank you for registering for Boot Camp for Couples! A confirmation will be sent to your e-mail
address.
Congratulations! If you’re on this page, you’ve decided to stop thinking and talking about getting you relationship in shape and are taking some action. Ready, set, GO!
REGISTRATION FORM
Date: ___________ How did you hear about Boot Camp for Couples? ____________________
Name 1: ______________________________ DOB: ___________ Sex: M F O
Address: ___________________________ City: _____________ St: ___ Zip: _______
Phone: (Home) ______________ (Cell) ________________ Email: _____________________
Birth Date: ____________ Occupation: _____________________ Marital Status: S M D W
Number of years married/together: ___________ Number of Children: _________
Name 2: ______________________________ DOB: ___________ Sex: M F O
Address: ___________________________ City: _____________ St: ___ Zip: _______
Birth Date: ____________ Occupation: _____________________ Marital Status: S M D W
Number of years married/together: ___________ Number of Children: _________
Select which level, session, or class(es) you will be attending from the list below.
Register for Level 1, Level 2, or Level 3, and receive a discount of $200 from cost if classes and consultations with Dr. Amy were purchased separately.
Register for Level 1 and Level 2, and receive a discount of $500 from cost if classes and consultations with Dr. Amy were purchased separately.
Select which Level, Session or individual class(es) you will be attending
___ Level 1: Basic Training: $1,025
Price includes two hours of *private consultation plus four weeks of Boot Camp. Select to
save $200 off cost if services were purchased separately.
___ Session A: Boot Camp meets on Saturday from 9:00am-11:00am
If you are not attending Level 1, select class(es) from the list below. Cost per class: $250. If you select two or more classes, cost reduced to $225 per class.
___ Basic Skills: June 15, 2013
___ Strengthen your Voice: June 22, 2013
___ Pucker Up: June 29, 2013
___ Muscle through the Tough Times: July 6, 2013
___ Session B: Boot Camp meets on Saturday from 1:00pm-3:00pm
If you are not attending Level 1, select class(es) from the list below. Cost per class: $250. If you select two or more classes, cost reduced to $225 per class.
___ Basic Skills: July 20, 2013
___ Strengthen your Voice: July 27, 2013
___ Pucker Up: August 3, 2013
___ Muscle through the Tough Times: August 10, 2013
*Couple consultation to be scheduled with Dr. Amy; one prior to and one after the Boot Camp.
___ Level 2: Interval Training: $1,025
Price includes two hours of *private consultation plus four weeks of Boot Camp. Select to save $200 off cost if services were purchased separately.
___ Session A: Boot Camp meets on Saturday from 1:00pm-3:00pm
If you are not attending Level 2, select class(es) from the list below. Cost per class: $250. If you select two or more classes, cost reduced to $225 per class.
___ Tag Team: June 15, 2013
___ Jumping through Hoops: June 22, 2013
___ Archery: June 29, 2013
___ Running the Marathon: July 6, 2013
___ Session B: Boot Camp meets on Saturday from 9:00am-11:00pm
If you are not attending Level 2, select class(es) from the list below. Cost per class: $250. If you select two or more classes, cost reduced to $225 per class.
___ Tag Team: July 20, 2013
___ Jumping through Hoops: July 27, 2013
___ Archery: August 3, 2013
___ Running the Marathon: August 10, 2013
*Couple consultation to be scheduled with Dr. Amy; one prior to and one after the Boot Camp.
___ Level 3: Intensive Training: $1,350
Cost includes three hours of *private consultation plus nine hours of Boot Camp. Due to the accelerated pace of this class, individual classes not offered. If these services were purchased separately, cost would be $1,525.
___ Session A
Day: Sunday; June 16, 30, July 14, 2013
Time: 1:00pm-4:00pm
___ Session B
Day: Sunday; July 14, 28, August 11, 2013
Time: 9:00pm-12:00pm
*Couple consultation to be scheduled with Dr. Amy; one prior to, one following week 2, and one after the Boot Camp.
___ I want to save $500 and registered for Level 1 and Level 2
TOTAL: ______
Proceed to check out.
Click here to schedule a private session with Dr. Amy.
Thank you for registering for Boot Camp for Couples! A confirmation will be sent to your e-mail
address.