Group Registration & Payment Form

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Thank you for registering for Paleo FX - Ancestral Momentum Theory to Practice

To complete the process, please provide your information in the secure payment and registration form below. Your card will be charged the full registration fee as follows:

10 to 24 Attendees in Group - $199 per attendee
25 or more Attendees in Group - $179 per attendee

Please note all registration fees are non-refundable. A member of the PaleoFX team will contact you directly to obtain the complete list of all attendees in your group for badge production, etc.

Yours in health,
The Paleo FX Team

Full Name (as it appears on card) *

Email *

Confirm Email *

Mobile Phone Number *

Number of Registrations for Group *

For Groups of 25 or More (# in Group)

Please confirm total # of attendees in Group

Full Name of Registrant 1 *

Full Name of Registrant 2 *

Full Name of Registrant 3 *

Full Name of Registrant 4 *

Full Name of Registrant 1 *

Full Name of Registrant 5 *

Full Name of Registrant 6 *

Full Name of Registrant 7 *

Full Name of Registrant 8 *

Full Name of Registrant 9 *

Full Name of Registrant 10 *

Names of Additional Registrants

Please include first and last names of additional registrants separated by commas

Billing Address *

Billing Zip Code *

Credit Card Type *

Credit Card Number *

Expiration Date (mm/yyyy) *

Security Code (3 digits on back or 4 digits on front for AMEX) *

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