LAM Team of 2

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Thank you for your donation which helps share the Living Active Method globally! (minimum donation: $249/person for 1 full year access)

If yes, what is the name of this learning group?

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If yes, what is the email of the person who referred you?

(Please check for accuracy!)

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First Name

Last Name

This donation is on behalf of a company

Phone

Learner #1 Name

(First Name Last Name)

Learner #1 Email

A unique email account is required for each learner.

Learner #2 Name

(First Name Last Name)

Learner #2 Email

A unique email account is required for each learner.

If yes, what is your group administrator's email address?

The group administrator will have access to your team's data collection and analysis

Please fix the errors above.

CARD BANK TRANSFER

Card Number

MM / YY

CVC Code

The 3-4 digits on the back of your credit card

Billing ZIP Code

Enter the Zip/Postal code for your credit card billing address

By clicking Donate, you authorise CHILDRENIC.ORG to debit the bank account that you connect to for any amount owed for charges arising from your use of CHILDRENIC.ORG’ services and/or purchase of products from CHILDRENIC.ORG, pursuant to CHILDRENIC.ORG’ website and terms, until this authorisation is revoked. You may amend or cancel this authorisation at any time by providing notice to CHILDRENIC.ORG with 30 (thirty) days notice.

If you use CHILDRENIC.ORG’ services or purchase additional products periodically pursuant to CHILDRENIC.ORG’ terms, you authorise CHILDRENIC.ORG to debit your bank account periodically. Payments that fall outside the regular debits authorised above will only be debited after your authorisation is obtained.

Bank Name

Account Type

Account Last 4

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