BREAK FREE North Jersey Program Registration

NEW JERSEY Program | FEBRUARY 10th & 11th, 2024

A 2-Day Psycho-Spiritual Educational Program

(✨For Adults Only, Ages 20+, Open to Both Men & Women)

Location: ICPC Red Manor House, 139 Derrom Ave, Paterson NJ

Time: 10 am to 5pm EST (both days)

✨Please Fill & Submit This Form To Complete Your Registration & Enrollment Into Program!

(Be sure to not skip questions or skip checks under terms and conditons before submitting)
Full Name of Student

First NameLast Name
Today's Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
How old are you?
Students must be 20 & up
Birth Date

MonthDayYear
E-mail of Student
Program I am Registering For:

Select your registration ticket below

BREAK FREE NJ 2024- REGISTRATION TICKET$199.99

Be sure to check this off to register

Total $0.00

Debit or Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

Terms & Conditions: Please read each of the following program agreement terms and check each one that you have read and agreed to. In addition, please sign below indicating you have read and agreed to the terms of this program:
By writing my name below, I understand that I am providing my signature indicating that I have agreed to sign up to the Break Free Program and have read and agreed to the terms and conditions stated above.
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