TBN Recharge Application

1
Name* This field is required.
First Name
Last Name
2
Email* This field is required.
example@example.com
3
Age* This field is required.
4
Are you a mother?* This field is required.
YESNO
5
Please give a brief description as to why you're looking to detox/cleanse/recharge your body:* This field is required.And why you want to join this program
Huge
Large
Normal
Small
Ok
Ok
6
Are you able to invest time and energy into this program?* This field is required.
YESNO
7
What is your motivation level from 0-10?* This field is required.0 being not motivated at all and 10 being extremely motivated
8
The TBN Recharge program will be in a group setting - are you comfortable being on this journey with others?* This field is required.
YESNO
9
Please share one thing you do every day to keep yourself in a positive mindset when times get tough.* This field is required.
Huge
Large
Normal
Small
Ok
Ok
10
You have two options to join this program:

1) Regular Group Member - you participate in this program in a group setting

2) VIP Group Member - you participate in this program in a group setting PLUS you get a private 1-1 session with Lauren during the program
11
TBN Recharge Program Payment* This field is required.I look forward to having you in the group!
prevnext( X )
My Bag
0
My Bag
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
ORDER SUMMARY
Total costUSD
TBN Recharge Group Program
$197.00Edit
Back
Regular Member
Regular Member
VIP
MEMBER OPTION
Total cost $0.00
Credit Card
First Name
Last Name
Should be Empty: