The Art & Science of Love

Registration

Select Workshop Date*
Please Select One
  • February 1-2, 2025
  • April 26-27, 2025
  • October 4-5, 2025
First Name*
Last Name*
Your Preferred Name for Table Tent*
Email Address*
Phone Number*
Billing Street Address*
Billing City*
Billing State*
Billing Postal Code*
Are You A Licensed Practitioner? (Select Your Licensure Below)
Please Select One
  • N/A
  • L.P.C. (Licensed Professional Counselor)
  • L.M.H.C. (Licensed Mental Health Counselor)
  • L.C.P.C. (Licensed Clinical Professional Counselor)
  • L.P.C.C. (Licensed Professional Clinical Counselor of Mental Health)
  • L.C.M.H.C. (Licensed Clinical Mental Health Counselor)
  • L.M.H.P. (Licensed Mental Health Practitioner)
  • M.F.C.C. (Marriage Family and Child Counselor)
  • L.M.F.T. (Licensed Marriage and Family Therapist)
  • L.C.S.W. (Licensed Clinical Social Worker)
  • Ph.D.
  • Psy.D.
License #
Partner's First Name*
Partner's Last Name*
Your Partner's Preferred Name for Table Tent*
Partner's Email Address*
Partner's Phone Number*
Is Your Partner a Licensed Practitioner? (Select Your Licensure Below)
Please Select One
  • N/A
  • L.P.C. (Licensed Professional Counselor)
  • L.M.H.C. (Licensed Mental Health Counselor)
  • L.C.P.C. (Licensed Clinical Professional Counselor)
  • L.P.C.C. (Licensed Professional Clinical Counselor of Mental Health)
  • L.C.M.H.C. (Licensed Clinical Mental Health Counselor)
  • L.M.H.P. (Licensed Mental Health Practitioner)
  • M.F.C.C. (Marriage Family and Child Counselor)
  • L.M.F.T. (Licensed Marriage and Family Therapist)
  • L.C.S.W. (Licensed Clinical Social Worker)
  • Ph.D.
  • Psy.D.
Partner's License #
If you need to cancel your registration you will receive a full refund, minus a $50 processing fee, provided your request is received prior to 3 weeks before the workshop. If your cancelation is received within 3 weeks before the workshop, you will receive a full credit to attend a future St. Louis Couples Workshop if scheduled within the next year.
This couples workshop is psycho-educational. It is not meant to be therapy. If you would like a referral to therapy we will be happy to help you. 
If you and your partner or spouse are seeing a therapist you may wish to schedule a session soon after the workshop for extra support. Are any of the following conditions present in your relationship?
Legal mandate to complete an anger management or domestic violence program.
A conviction of assault or domestic violence.
Unwanted physical aggression in your relationship.
Issues, conditions or concerns that might affect your participation in the workshop.
If any of these conditions exist, Richard or Christianne will discuss them with you during your phone call. 
Closer to the workshop, each member of each couple has their own   phone call with Richard or Christianne to answer any questions about the workshop, to hear what attracted you to the workshop and help us ensure that the workshop may be useful for you and your partner.
How Did You Hear About Us?*
Please Select One
  • Friend or Family Member
  • Facebook
  • Google
  • Counselor Referral
  • Eventbrite
  • Groupon
  • Print Ad
  • Other

Please Tell Us About Food Allergies or Any Other Accommodations You Need.*

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