New Paradigms Small Group Intensive Program

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

I understand that I need to complete a 90-minute assessment ($200.00) with Nimisha Patel before I join the New Paradigms Small Group Intensive (required from all attendees.). I will review, complete, sign and bring the New Paradigms Small Group Intensive Agreement Form to my initial assessment session.

I also understand I have the following option to pay for the group sessions:

• $80.00/90 minute group. I understand that the first payment of $320.00 ($80.00 x 4) for the first four weeks will be collected before the group. (I understand I will be charged $320.00 for the second and third four weeks.)
• $75.00/90 minute group. I understand that this is collected as one payment of $900.00 for 12 weeks before the group starts.

Please Select A Group

Monday 4:30pm to 6:00pm starting January 27th, 2020
Wednesday 9:00am to 10:30 am starting January 29th, 2020
Thursday 10:00 am to 11:30 am starting January 30th, 2020

Initial Assessment *

Price: $200

Choose One Below *

The first payment of $320.00 for the first four weeks. (I understand I will be charged $320.00 for the second set and third set of four weeks.)
One Time Payment: $900.00 for 12 weeks.

Total Amount

$ 0.00

I agree to the conditions above & check this box as my electronic signature

Name *

Date Of Agreement *