October 25th Retreat Registration Form
Please fill in the form below.
Name
*
First Name
Last Name
Mobile Number
*
-
Area Code
Phone Number
E-mail
*
How did you hear about Release™️?
You’ll receive an email from me a few days before the retreat, anything you’d like me to know until then?
Fee for this retreat is $125 due now to secure your spot. How would you like to pay?
Via PayPal using product button below
Via my credit card using HIPPA compliant “IVY Pay” available exclusively to Therapists (you will receive a text within the next day or two prompting you to enter credit card details)
Payment Button:
*
Release™️ Friday Oct 25, 2019 9:30-3pm
$
125.00
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