Registration Form

Print this form, fill it out and mail it to us.

Fax it to 973-866-0211 if paying by Credit/Debit Card

We accept VISA ~ MASTER CARD ~ Credit or Debit Cards

Name: ________________________________________________________________

Address: ______________________________________________________________

City: ________________________________ State _____________ Zip ___________

Email _________________________________________________________________

If paying with Visa or Master Card fill in this section:

Your Card #: ______________________________________Exp Date: ___________

                 3 Digit Security #'s on back of card: __________

 Signature: _____________________________________________________________

If paying by check simply make it out to

Metro Lifeforming Coaching Center

Then mail your check to:

Metro Lifeforming Coaching Center

PO Box 1128

Brookdale Station, NJ 07003-1128

 

Group Rates

Put a group of 6 people together and save $5.00 each

$45.00 per person

 Put a group of 10 people together and save $7.00 each

$43.00 per person