Core Strength Workshops Form

Core Strength Registration Form
Registration for Self-Care Workshops

Instructor: Dr. Heather LaChance
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Select the self-care workshop you are most interested in:*
My Products
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Growth Mindset for Weight Loss9/9/2025 5:30 pm - 8:00 pm
$150.00 Quantity



Growth Mindset for Weight Loss9/16/2025 5:30 pm - 8:00 pm
$150.00 Quantity



Growth Mindset for Weight Loss9/30/2025 5:30 pm - 8:00 pm
$150.00 Quantity



Total

$0.00
What personal challenge, goal, or event (health, weight loss, postpartum, wedding, etc.) would you like to address?*
Just a few sentences so I can customize your experience.
Age range (*must be older than 18 years of age)

Less than 1818 - 2930 - 3940 - 5556 - 6970+
Payment Methods

Fastlane Checkout

Choose from one of the PayPal options to make your payment.

Contact Info

Payment Info
Should be Empty:

Core Strength Registration Form