Couple Actualized Group Registration 
This group is for couples.  We must have a minimum of four couples to form. You will be notified when the group forms. We meet on the 4th Wednesday of the month. 
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Email *
First and Last Name
First and Last Name *
Age Range  *
Can you commit to 8 group sessions?  *
Group Fees *
Email address *
Email address *
Phone number *
Phone number *
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