Paying by Check

Fill out the form first , then print and mail with your personal check to Peg Beehan.
After printing, please hit the submit button to reserve your spot in the workshop.
PLEASE NOTE:
 You must print and mail the completed form with your check.

MAKE CHECKS PAYABLE TO:
Peg Beehan
1508 Clayton Ave.
Nashville, TN 37212
Phone Message: (615) 269-4080

 
Your Name
Spouse/Partner Name
Street Address
City
State
Zip
Your Email Address
Spouse/Partner Email
Your Phone
Spouse/Parner Phone
Special Contact Info

$160- Initial Evaluation
$135 - Individual, Couples and Family counseling
$45 - A Time To Remember - Group Once
$75 - A Time To Remember - Couple

You are paying by sending a check.
Please enter the date it will be mailed:
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If so, with whom?
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