7 Steps Retreat Registration
** IMPORTANT ** If this retreat is part of your BALM program, after providing your contact information below, please scroll to the very bottom of this form and use your coupon code to complete your registration. If you don't have your coupon code, please email us at support@familyrecoveryresources.com
Name
*
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail
*
example@example.com
Phone Number
*
Cell Phone
Person #2
(If enrolling a second person for the Retreat)
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Choose your payment option & we will contact you for payment.
Zelle - to bbuncher@familyrecoveryresources.com
ACH Direct Deposit (Add your Routing Number and Acct Number below)
Check to Family Recovery Resources, LLC, c/o Beverly Buncher, 6698 Tenth Ave N Apt 318, Lake Worth, FL 33467
Routing Number
required for a direct deposit ACH payment
Account Number
required for a direct deposit ACH payment
I am enrolled in the BALM and I have a coupon code.
Please enter coupon code below:
Coupon Code
Complete my Registration
Should be Empty: