Course Dates

Name You Like to be Called

Birth Date

MM/DD

Email

How I spend much of my time (primary vocation or passion)

Sponsor

Who referred you to LifeResults?

Dietary Comments

Enter any additional comments related to your dietary needs

Physical/Emotional/Health/Dietary Concerns

Goals

What are your goals for attending this seminar?

Form Completed By

If you are completing this form for someone else, please provide your name here (in case there are questions).

Unconditional Gaurantee

If, after completing the entire three days of the LifeResults Core Seminar, you feel that you did not benefit, you may submit a written request for a refund. Your tuition will be immediately and cheerfully refunded (less the $95 non-refundable registration fee). The Seminar Director or other LifeResults Board Member must receive this written request within three (3) days of completion of the LifeResults Core Seminar.

Register particpant for IPI when payment has not been arranged yet