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Moore Counseling 303 W. Walnut St. Kalamazoo, MI 49007 (269) 303-9586 moorer@moorecounselingcenter.org www.moorecounselingcenter.org

Group Registration Form (Please print this form and complete payment information and send to address above)

Name: Address: Phone: (H) (C) Email: Group name: How did you hear about the group? May we send materials and other paperwork, if needed, to the address above? Yes or No If not, please write a note on back as to preferred method. Payment Information: Check (payable to Moore Counseling): Credit Card: Enter Card #: CVV Code: Signature:

Billing Zip Code:

Specific Group Information: Group Name Junior Academy

Payments $35, $40

Transparent

$40, $40, $40

You are a Badass

$56*, $40, $40 *Includes book fee $40, $40, $40

Positive and Negative

Due Dates Upon Reservation, June 26 Upon Reservation, Sept. 3, Oct. 8 Upon Reservation, Sept. 4, Oct. 9 Upon Reservation, Sept. 8, Oct. 13

Event Dates/Times June 24-26, 6:00PM7:30PM Wednesdays, Sept. 3 to Oct. 8, 6:00PM-7:00PM Thursdays, Sept. 4 to Oct. 9, 6:00PM-7:00PM Mondays, Sept. 8 to Oct. 13, 6:00PM7:00PM

Group Registration Form  

This is a group registration form for Moore Counseling, Kalamazoo, MI. Updated 05/21/14.

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