LAM Team of 6

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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)

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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

Email

Phone

Learner #1 Name

(First Name Last Name)

Learner #1 Email

A unique email is required for each learner

Learner #2 Name

(First Name Last Name)

Learner #2 Email

A unique email is required for each learner

Learner #3 Name

(First Name Last Name)

Learner #3 Email

A unique email is required for each learner

Learner #4 Name

(First Name Last Name)

Learner #4 Email

A unique email is required for each learner

Learner #5 Name

(First Name Last Name)

Learner #5 Email

A unique email is required for each learner

Learner #6 Name

(First Name Last Name)

Learner #6 Email

A unique email 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

CVC Code

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

Billing ZIP Code

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Bank Name

Account Type

Account Last 4

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