2024 LifeWise Summit Registration

First Name

Last Name

Street Address

City

State

Zip

Mobile Phone

T Shirt Size

I am registering as a

LifeWise Program

Fall 2024 will be the first year for our LifeWise program OR I am new

Yes, 2024 is our / my first yearNo, we are an established program / I served or worked with LifeWise before

Dietary Restrictions

Please list your dietary restrictions

We have blocked off rooms at local hotels. Will you require a room?

Yes

NO PAYMENT REQUIRED - The registration fee will be transferred from your local program fund (or account)