Registration Art of Being You

Art of Being You
Application and Registration
This application does not guarantee registration. Attendance is based on space available and pre-approval by group facilitator.

Group meets on Wednesdays at 5:45-7:45 p.m.

2014 Dates
March 5- April 16, 2014
April 30- June 1, 2014
Sept. 10-Oct. 22, 2014
Please check back for other upcoming workshop or retreat dates.

Name *

First

Last

Phone Number *

Email *

Welcome to Art of Being You Application and Registration. Please check all that apply. *

I am interested in the Art of Being You group. Please contact me to provide more information or to set up an initial intake interveiw. This is the first step! I look forward to speaking with you! I’M TAKING THE LEAP! I have met with Robin and will use one of the following payment options to register and reserve my spot. Congratulations and welcome to the Art of Being You! Pay by Cash or Check: Discount rate of $280 for entire 7 weeks. I will mail check or drop off cash to Robin Friedman 1235 SE Division St. Suite 202B, Portland OR 97202. Pay by PayPal: Discount rate of $280 for entire 7 weeks to Robin@robinfriedmantherapy.com (please discuss with Robin prior to using this option). Credit Card: Discount rate of $280 for entire 7 weeks. (Please call with credit card information. 3% fee will be added to cover fees). INSURANCE: Upon Pre-approval, I will pay my co-pay as discussed with Robin. Full insurance rate will be owed until deductable has been met. Pay weekly: $45 per session. I will bring a check or cash to each session, or pay prior to session with paypal. No credit cards accepted the night of group. Other (please write in below). Please put me on your mailing list for upcoming groups and workshops!

Please tell me a little bit about your interest in this group, how you found out about it, and any group experience you have. Thank you. *

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Robin Friedman Therapy Expressive Arts Portland Oregon