Transpirational Adventures Registration Form

Transpirational Adventures Registration Form
Name *

First Name Last Name
Email *
example@example.com
Phone Number *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Emergency Contact Name *

First Name Last Name
Emergency Contact Phone Number *
Please enter a valid phone number.
By registering for this event, you agree that you have read and understand the Imagine Living Well Release and Waiver which can be found here.
Release and Waiver Confirmation *

Yes, I confirm I have read and understand and agree to the Imagine Living Well Release and Waiver on behalf of myself and any minor children or others over whom I have guardianship listed below.
Please list any minor children or adults for whom you have guardianship who will be accompanying you on this Transpirtational Adventure and on whose behalf you are acknowledging and agreeing to the Imagine Living Well Release and Waiver (if applicable).
Example: First Name Last Name, Age, Relationship (i.e. parent, guardian)

Select Your Adventure! *

True Colors Tour

$ 50.00 Quantity

Peace Train

$ 40.00 Quantity

I Am Well

$ 30.00 Quantity

Waterfalls Tour

$ 50.00 Quantity

Polar Express

$ 25.00 Quantity

Mind/Body/Spirit

$ 30.00 Quantity

Marketing Tour

$ 500.00

Guest

Free

Enter coupon

Total

$ 0.00