Prime For Life Registration Form

"*" indicates required fields

Participant Name*

First Last Suffix

Participant Email*

Enter Email Confirm Email

Participant Phone*

Current Mailing Address*

Please provide an address where your Participant Workbook can be mailed.

Street Address Address Line 2 City State ZIP Code

Referral Source*

Please indicate SPECIFICALLY who referred you to Prime for Life (i.e. Plymouth Police Department, NH Liquor Enforcement, etc).

Available Course Dates*

Prime for Life is taught on Zoom. There is an enrollment cap for each course. Registration is on a first come, first serve, basis. You will be contacted to confirm your enrollment.

Registration Fee – PayPal*

A flat $350 registration fee via PayPal will be required to take Prime for Life. No additional donation is needed.

Price:

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