SELECTED WORKSHOP *Required fields

REGISTRATION

Are you rescheduling from a previously missed workshop?*

Have you previously received a home-delivered Confidence Kit?*

Are you a health professional registering to observe a workshop?*

PLEASE ASSIST US IN COMMUNICATING WITH YOU EFFICIENTLY BY PROVIDING A VALID EMAIL ADDRESS. THIS WILL GREATLY ASSIST IN OUR EFFORTS TO MINIMISE THE COSTS OF ADMINISTERING OUR PROGRAM.

THANK YOU FOR TAKING THE TIME TO PROVIDE US WITH INFORMATION THAT WILL HELP US ENSURE YOU GET THE MOST OUT OF YOUR LOOK GOOD FEEL BETTER EXPERIENCE.

Have you filled this form on behalf of someone else?

Would you like to receive future communication from Look Good Feel Better?*

Please note, this person will not participate in the program and won’t be seated with you. We ask that they are there to observe only.