Reclaiming Health And Vitality! Registration Form

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Begins Tuesday, Nov.9th at 7pm on Zoom and runs each Tuesday night finishing on Dec.14.21

Email *

First and Last Name *

City, Province and Country you live in *

Please read and check each item: *

Check here:

I understand that payment for this program is due upon registration to reserve my spot and I will be contacted to arrange payment by etransfer, paypal or credit card.

I understand that all sessions will be recorded, that I will be sent a link for viewing and that I am not to share these recordings with anyone else to ensure the privacy of all participants is maintained.

I understand that every body is unique and that results may vary.

I understand that this program is not to take the place of seeking professional medical advice for my healthcare needs.

I understand and agree that I am responsible for seeking out professional medical advice when needed.

Check here:

I understand that payment for this program is due upon registration to reserve my spot and I will be contacted to arrange payment by etransfer, paypal or credit card.

I understand that every body is unique and that results may vary.

I understand that this program is not to take the place of seeking professional medical advice for my healthcare needs.

I understand and agree that I am responsible for seeking out professional medical advice when needed.

Signature: Type Your Full Name *

Signature Date (Choose Today's Date) *

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Time *

Time

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