40-Day LTE Registration Payment Form

First Name *

Last Name *

Address

Street Address *

City *

State *

Country *

Postal code *

Phone *

Email *

Will your spouse be attending the 40-Day?

Media Release Consent: I understand that photos and/or videos may be taken during this event for use in marketing materials.

Testimonial Release Consent: I understand that my responses to course feedback or evaluation forms may be used to create marketing materials.

Please Select Payment Amount ($300/single or $600/couple) *

$ 300

$ 600

Please consider adding 3% to your payment to cover the CC processing fees. Thank you.

By checking this box, I consent to receive transactional messages related to my account, orders, or services I have requested. These messages may include appointment reminders, order confirmations, and account notifications among others. Message frequency may vary. Message & Data rates may apply.Reply HELP for help or STOP to opt-out.

By checking this box, I consent to receive marketing and promotional messages, including special offers, discounts, new product updates among others. Message frequency may vary. Message & Data rates may apply. Reply HELP for help or STOP to opt-out.

Agreement *