NLXF REGISTRATION PAGE

NAME

EMAIL

example@example.com

BIRTHDATE

HAVE YOU EVER TAKEN A CLASS AT NLXF BEFORE?

WHICH CLASS TIME DO YOU PLAN ON ATTENDING THE MAJORITY OF THE TIME?

SUMMER SPECIAL 8-WEEK SESSION

$250.00

6-MONTH EFT

REQUIRES 6-MONTH COMMITMENT. BECOMES MONTH-TO-MONTH MEMBERSHIP AFTER 6 MONTHS. 30-DAY NOTICE REQUIRED TO CANCEL

$109.00

4-PERSON SUMMER SPECIAL

($200/PERSON - YOU WILL ENTER THE OTHER GROUP MEMBERS' NAMES BELOW)

$800.00

Total

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

NAMES OF OTHER GROUP MEMBERS