Registration form for Taking in the Good: Unlocking Health and Happiness

Disclosure Form- Please click to download and read the Disclosure form

Name *
Name
Address *
Address
Home Phone
Home Phone
Cell Phone
Cell Phone
I have received and read the Disclosure form. By clicking "yes" below, you are agreeing to maintain strict confidentiality about the names and associated issues of the members of this group or partciapants at the Event. FAILURE TO COMPLY WITH THIS WILL RESULT IN YOUR TERMINATION OF THIS GROUP OR PARTIPATION AT THE EVENT. I HAVE READ AND UNDERSTAND (OR HAVE ASKED FOR CLARIFICATION OF) THE INFORMATION PRESENTED IN THIS FORM. A copy of this document has been given to me for my records. I consent to participation in a Desert Hope Event. *