"Keep It Under Control | Control Anger Before It Controls You"! Join our Anger Management Classes Today! | Call 323.756.1713
Dr. Anthony Young PhD, CAMF-Founder
Registration Pre-Registration Form Questionnaire
What you must do to pre-register*Email Us *Send us your contact information*The reason for taking the class *Be willing to pre-pay for all classes *Required Field
What you must do to pre-register*Email Us *Send us your contact information*The reason for taking the class *Be willing to pre-pay for all classes
*Required Field
*First Name: Last Name: Reason for wanting to take the anger management classes:
What class/classes are you interested in? What time are you looking for to enroll in our program? Are you a employed full time? How Did you Hear About Us? Select One Advertisement Friend/co worker Job Referral Court System Internet Search Other Select One Advertisement Friend/co worker Job Referral Court System Internet Search Other Contact Phone Number: *Email Address: *If classes are available will you commit to taking all classes? Yes No
If you checked no please explain. If you are enrolled into our program are you willing to pay in advance? *Yes No If you checked no please explain If you are just seeking information regarding our program please enter your comment or concern: Thank you and a representative will be contacting you. Questions? Call 323.756.1713 Email Address: kiuc1@aol.com
