Registration Form for

"Virtual Gastric Band Program"

6 Day ONLINE GROUP INTENSIVE

Class held each Day from 7-9 pm EST

Monday, May 12 thru Saturday, May17, 2018

Register Deadline is Thursday, May 112018 @ 11 pm EST

Please tell me how you learned about this Program! (So I can thank that person or know how to spend my advertising dollars in the future?)

Your Name:

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Authorization for credit card charges made to REGISTER for the Virtual Gastric Band ~ 6 Day INTENSIVE GROUP PROGRAM

I authorize Linda Greenfield to securely charge the indicted fee above via Point of Sale (Previously Square) to my credit card information below. My payment of this fee is for my attendance to the Virtual Gastric Band GROUP INTENSIVE PROGRAM of 6 Classes (one class held daily for 2 hours each over 6 days) beginning on Monday, May 14 thru Saturday, May 19, 2018.

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Any Questions or Comments?

REFUND POLICY:

Refunds for any pre-registered Courses or Workshops (less $25 for processing fees) provided only by cancellation request received in writing (email or letter) at least three (3) days prior to the scheduled start date of Course or Workshop.

Other information:

Linda personally processes all credit card payments through Point of Sale (Previously Square). Point of Sale will e-mail to you a receipt for your payment. You will also receive a printed receipt directly from Linda for your payment at the first class.

If you need to contact Linda Greenfield for any reason, call 305-519-9711 and plan to leave a voice message.