The Primal Man Project
Click on the link below to be directed to the Primal Man Project Registration Page.
Click here
Do
not
choose "Submit" below.
First and Last Name
*
First Name
Last Name
Phone Number
*
This is important for last minute updates.
E-mail
*
example@example.com
What are you hoping to gain from attending these classes & courses?
Your Age
(These classes are for men only)
Emergency Contact's Name
*
First Name
Last Name
Relationship
*
Please Select
Partner
Mother
Father
Grandparent
Aunt
Uncle
Sibling
Babysitter/Nanny
Other
Phone Number
*
Alt. Phone Number
Guest's Name
First Name
Last Name
What is your guest hoping to gain from attending these classes & courses?
Guest Age
(These classes are for men only)
Do you or your guest have any allergies, chronic illness, psychological disorders or medical conditions? If yes, please describe. Your honest and accurate response is quite important. We want to serve you the best that we can and this information helps us to do so.
*
Are you or your guest prescribed an inhaler or an EpiPen? If yes, please explain any unusual instructions in case you are not able to administer self first aid.
*
Date
-
Month
-
Day
Year
Date
Signature
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Directly below this text, you will see the PDF Pack List. This will be used for any and all adults only classes.
Save
Submit Form
Submit Form
Should be Empty: