Holistic Addiction Recovery

Holistic Addiction Recovery

Registration
Name*

First NameLast Name
E-mail*
example@example.com
Phone Number*
Suggested cost for this program is listed below, however it is offered on a Pay As You're Able basis. Please indicate which program(s) you are registering for:*

Groups for Participants only (Suggested cost $80)Add on Groups for Family Members for an additional $40 (Suggested cost: A total of $120)
Today's Payment Amount:

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Payments are processed through PayPal. You may pay using an existing PayPal account, or any major credit card / debit card.

Payment Methods

Debit or Credit Card

Please click one of the PayPal options to complete payment and submit the form.