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 of $249 per person. $199 is the student and senior rate (55 and older). Any applicable promo codes will be applied to your total as well.

*******Note: PaleoFX Ticket Price Change - Effective March 1, 2012, Ticket Prices will be $299 per person, $249 for students and seniors. This pricing change will not effect any orders placed on or before February 29th at Midnight Central.***

Please note all registration fees are non-refundable.

Yours in health,
The Paleo FX Team

Group Registration is available for groups looking to purchase 10 or more tickets together. Form is available here https://docs.google.com/spreadsheet/viewform?hl=en_US&formkey=dDBOV1A0N0xLZ1ZZN3lXX01iLWpDaVE6MA#gid=0

Full Name (as it appears on credit card) *

Email *

Confirm Email *

Mobile Phone Number *

Number of Registrations *

Number of Student or Senior Registrations

Full Name & Company Affiliation if applicable (for name badge) *

Registrant 2 Full Name & Company Affiliation (when applicable)

Promo Code

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) *

Submit

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