Workshop Name:
Choose one
The Discovery Workshop Sept
The Discovery Workshop Oct
The Breakthrough Course
The Discovery and Breakthrough
The Leadership Program
The Breakthrough and Leadership
The Discovery Workshop Español
The Discovery and Breakthrough Español
The Journey Español
The Abundance & Prosperity Workshop
Workshop Price:
Choose one
The Discovery $395
The Breakthrough $1095
The Discovery and Breakthrough $1,295
The Journey (Discovery, Breakthrough and LP) $1895
The Leadership Program $895
The Breakthrough and LP $1595
The Discovery Español $295
The Discovery and Breakthrough Español $1,295
The Journey Español (Discovery, Breakthrough and LP) $1895
The Abundance & Prosperity Workshop $195.00
First Name:
Last Name:
Nickname (preferred name):
Mailing Address (Only fill out if different than billing address)
Address 1:
City:
Address 2:
State:
Zip Code:
Phone Numbers
Home:
Best time to call:
8:00am
9:00am
10:00am
11:00am
12:00pm
1:00pm
2:00pm
3:00pm
4:00pm
5:00pm
After 5:00pm
Work :
Best time to call:
8:00am
9:00am
10:00am
11:00am
12:00pm
1:00pm
2:00pm
3:00pm
4:00pm
5:00pm
After 5:00pm
# of Children:
Ages (ie: 3, 5, 12):
Referred to this workshop by:
Occupation:
Birth Date:
Please list three things you would like to accomplish by participating in this workshop:
Pricing & Refund Policy Statement
I have read, and agree to, the Pricing & Policy Statement above.
