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Co-Parenting Resolution
Parent/Professional Registration
 


YOU MAY PRINT THIS FORM AND FAX TO (770) 642-1104 TO ORDER THE SERVICES, BOOKS, AND TO REGISTER FOR THE CO-PARENTING RESOLUTION TRAINING COURSE.

YOU MAY ORDER ONLINE THE BOOKS, SERVICES, AND THE CO-PARENTING RESOLUTION TRAINING COURSE BY USING PAYPAL.

_____ PLEASE MAIL ME _____ COPY(IES) OF HOW TO SURVIVE AND WIN AS A CO-PARENT (SECOND EDITION) INCLUDING THE KERMAN CO-PARENTING PLAN
ON A WRITABLE CD IN WORD AND WORDPERFECT FORMATS. 
THE COST PER COPY IS $25.00 PLUS $9.00 THAT INCLUDES SHIPPING AND TAX.

_____ PLEASE MAIL ME ______ COPY(IES) OF DO YOU REALLY WANT TO BE A STEPPARENT? (SECOND EDITION) $25.00 PER COPY INCLUDING TAX AND SHIPPING.

_____ PLEASE CALL ME AT _____________________ TO ARRANGE FOR AN APPOINTMENT FOR THE DOMESTIC MEDIATION SESSION, CASE EVALUATION/DOMESTIC RELATIONS SESSION, AND ARBITRATION SESSION.  I UNDERSTAND THAT THE FEE IS $100.00  PER HOUR PER PARENT AND THAT EACH PARENT RECEIVES A COPY OF HOW TO SURVIVE AND WIN AS A CO-PARENT (SECOND EDITION) INCLUDING THE KERMAN CO-PARENTING PLAN ON A WRITABLE CD IN WORD AND WORDPERFECT FORMATS.    

_____ PLEASE CALL ME AT ______________________ TO ARRANGE FOR A
DIVORCE AND CUSTODY CONSULTATION.  I UNDERSTAND THAT THE FEE
IS $350.00.    


_____ PLEASE SEE THE REGISTRATION FORM PAGE TO REGISTER FOR THE
INSTITUTE FOR CO-PARENTING RESOLUTION TRAINING COURSES FOR PARENTS
AND PROFESSIONALS.              

       

PLEASE CALL TO SCHEDULE ANY OF THE SERVICES OR ORDER ANY OF THE PRODUCTS.   

NAME: ______________________________________________

ADDRESS: ___________________________________________

CITY: _________________ STATE: ____________ ZIP: ______

PHONE NUMBER: ______________ FAX NUMBER: ____________

PAYMENT METHOD: VISA ______   MASTERCARD ______

CARD NUMBER: ____________________ EXP. DATE: ________ 

THREE DIGIT NUMBER ON BACK OF CARD: _________________

NAME ON CARD: _____________________________________

SIGNATURE: ________________________________________

DR. ARLINE S. KERMAN

8725 ROSWELL ROAD, SUITE O-210

ATLANTA, GEORGIA 30350

PHONE: (770) 642-1100; FAX: (770) 642-1104

DRARLINEKERMAN@AOL.COM



 
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