Weekend Registration Form...

Cost

A $225 fee provides the Beginning Experience Weekend program, program materials, two nights' lodging and five meals. A $25 non-refundalbe deposit (part of this $225 fee) with your registration holds your spot. The deposit is non-refundable (since we must also make a non-refundable deposit to hold your spot) but may be applied to a future weekend. Partial scholarships and payment plans are available on request.

Questions

For any questions about registering for a Beginning Experience Weekend, please contact the registrar at registrar@seattlebe.org

Mail In Registration


Microsoft Word - Rich Text Format	Adobe Acrobat	Text	GIF

Fax in Registration

Please click on one of the registration form icons above (Microsoft Word, Adobe Acrobat, Text, or GIF), print out the form, fill out the information, and fax to our eFax number (419) 821-4629. Then follow the instructions at the bottom of this page for making your deposit.

On-Line Registration

Please fill out the following information and when finished click on Register. The registration program will bring you to another page showing you the information that was sent to the registrar. PLEASE CLICK THE BACK ARROW BUTTON ON YOUR WEB BROWSER TO COME BACK HERE AND PAY THE DEPOSIT ONLINE OR MAIL A CHECK FOR THE DEPOSIT.

To pay on-line, click on the Google Checkout or PayPal buttons to pay your deposit Then log into your Google Checkout or PayPal account or create an account. In the "Payment For" box fill in "your name". For the "Amount" fill in $25 for the non-refundable deposit or you may pay the full amount of $225 at this time. If you are paying only the deposit now, you may pay the remainder of the weekend fee when you arrive or you may either pay the remainder by check by mailing to Beginning Experience of Seattle, 9594 First Ave. NE #302, Seattle, WA 98115-2012, by using Google Checkout or by using PayPal to pay the remainder. Finally, Click on "Buy Now" or "Pay".

I'm interested in making a Beginning Experience weekend.

Please choose a weekend date	October/November 2008 May 2009
Name
Address
City	State Zip
Home Phone	Work Phone
Cell Phone	E-mail
Emergency Contact	Phone Number
Religious Affiliation/Parish

Marital Status:

How long were you married?
If widowed, how long have you been widowed?
If separated, how long have you been separated?
If divorced, how long have you been divorced?

You and Your Family:

What is your age?
What is your gender?	Female Male
Number of Children
Children's ages

How did you hear about the Beginning Experience program?

What do you hope to gain from the program?

Special Needs:

Do you have any special needs we should be aware of such as physical or dietary limitations?	Yes No
If yes, please specify

Counseling or Therapy:

Are you presently in counseling/therapy?	Yes No
If yes, counselor's name
Address
Phone

Beginning Experience of Seattle may contact my counselor or therapist concerning my participation in the Beginning Experience weekend.

I agree: Yes No

Comments:

Deposit for the Weekend:

You may pay your deposit on-line via Google Checkout or PayPal you mail your deposit. You may use credit cards and electronic fund transfers with Google Checkout and PayPal. You may use check or money orders by mail.

To Pay by Mail:

Mail your check or money order to:: Beginning Experience of Seattle; 9594 First Ave. NE #302; Seattle, WA 98115-2012

To Pay On-Line via Google Checkout:

Select the amount from the drop down box below ($25 for deposit, or $225 for full registration fee).

Log in - or create an account - with Google Checkout (if you do not have an account, they will create one for you with your credit card)

To Pay On-Line via PayPal:

Click on the "PayPal Donate" button: Log in - or create an account - with Pay Pal (if you do not have an account, they will create one for you with your credit card); Payment Amount = $25.00 as a non-refundable deposit for the weeked. If paying full $225 amount we suggest that you pay $231.82 to cover the 2.9% processing fee and $0.30 transaction fee that PayPal charges us.; Click on Pay