Event Registration
Your registration is complete when you have filled out this form AND completed payment. You will receive a confirmation email with a receipt after payment is received. If you have any questions please email Lily Stokely at drlily@lilystokely.com.
Email address *
Name (First and Last) *
Your answer
Email Address *
Your answer
Billing Address *
Your answer
Phone number *
Your answer
Registration Option
Column 1
Standard Registration $550
NMSA Member $525
Payment Preference
Column 1
Mail Check
Payment - Mail Check
If choosing to mail a check for payment, please write check payable to:
The Body Positive

Mail Check to:
Lily Stokely
5414 Barnes Ave NW, Ste 1
Seattle, WA 98107

Payment - Credit/Debit
Pay by debit or credit card through PayPal by following this link: paypal.me/thebodypositive
Questions and comments
Your answer
A copy of your responses will be emailed to the address you provided.
Never submit passwords through Google Forms.
This form was created inside of Lily Stokely, ND. Report Abuse - Terms of Service