This form cannot be submitted online. You must print it, fill it out, and then mail or fax it to us.

Searching for Courtship Workshop Leader Application and Order Form

Name:_____________________________ Professional/Academic title:_______________

Address: __________________________________________________________________________

Phone/fax:_________________________ Email:_______________________________________

Occupation: ________________________________________________________________________

Name of practice or medical affiliation (if applicable)
_______________________________________________________________________________________

Briefly list credentials and degrees: _______________________________________________

Please describe how you intend to conduct your workshops . For instance: in your counseling practice, as a sponsored educational class, for a singles event, or informally with a group of single women?
_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________


I present this information as accurate and hereby apply for an Athena Workshop Leader License:

Date__________ Signature ___________________________________

Athena Institute welcomes all applicants interested in becoming a Workshop Leader using the Searching for Courtship materials. Athena does reserve the right to review and reject Workshop Leader applicants it deems unqualified.

Place your order:
Workshop leader kit @ $229.00_______ Mc/Visa/Discover
Shipping charges @ $20.00 ________ ______- ________ - _______- ________ Exp ______
or Fedex charge @ $45.00 ________ Signature: __________________________________
Sales tax (pa only) add 6% $_______
Total enclosed $________ Money orders or Checks to "Athena Institute"

Shipping address if different from above: __________________________________________________________
(must match credit card billing address)

Please contact Athena Institute with any questions via phone : 610-827-2200
Email: athena@athenainstitute.com
Fax or mail this form with your payment to:
Athena Institute, 1211 Braefield Rd., Chester Springs, PA 19425 Fax: 610-827-2124
Or if you prefer, you can phone in your order (610-827-2200) or you can fax or mail it using the order form below. You can also e-mail us to receive free printed info (please state in your message which products interest you, and provide a mailing address).