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Your Story, Your Legacy Registration

Name *

First

Last

Email *

Phone *

Mailing Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Workshop Date *

Select from 3 workshop dates in 2022

Dietary Restrictions? *

Identify dietary preferences for workshop lunch.

Cost per person

Price: $120.00

Billing Address (if different from above)

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Pay by Credit Card *

Card Number

Expiration

/

Security Code

Comments or Questions