Soul on Fire Registration and Payment Form

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Soul on Fire Registration Form

To register, please fill out this form and press the ’Submit’ button. You will then be prompted to review and sign a Disclaimer, Release and Indemnity form.

Name*

First NameLast Name

Referred by

Primary E-mail*

Primary Phone Number*

USA phone number

City and State/Province*

Are you 18 years of age or older?

YesNo

My Products

Cost per participant for Soul on Fire$100.00

penny test$0.01

Total $0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Financial Assistance

If you need financial assistance contact Sheryl at Sheryl@heartofthematterretreat.org

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I agree to the Terms and Conditions, and Privacy Policy linked below

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PLEASE READ:
Now that you’ve completed the registration form, please click the button below to access the mandatory Disclaimer, Release, and Indemnity Form, which must be signed before joining Soul on Fire.

Thank you!