Menopause Bootcamp Registration

Name(Required)

First Last

Email(Required)

Phone

Are you a member of TIOH?(Required)

Yes

Not yet, but thinking about it

How many guests are in your party including yourself?(Required)

Guest 1 Name(Required)

First Last

Guest 1 Email(Required)

Guest 2 Name(Required)

First Last

Guest 2 Email(Required)

Guest 3 Name(Required)

First Last

Guest 3 Email(Required)

Guest 4 Name(Required)

First Last

Guest 4 Email(Required)

Bootcamp Cost

($36/per person)

Amount: $0.00

Would you like to purchase a copy of Dr. Suzanne's book, "Menopause Bootcamp: Optimize Your Health, Empower Your Self, and Flourish as You Age"?(Required)

Yes

How many copies?(Required)

($18/per hardcover copy + 9.5% sales tax)

Book Cost

Amount: $0.00

Billing Details

Subtotal

$0.00

cc fees

I wish to cover credit card fees for the temple by increasing my total by 3%

Credit Card Fee

$0.00

Total

Credit Card(Required)

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Billing Address(Required)

Street Address Address Line 2 City State ZIP Code

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