Please print out the following order form and either:
1. Fax it to (434) 978-0118
2. Mail it to:
Ultimate Lifestyle Academy
690 Berkmar Circle
Charlottesville, VA 22901
Please fill in the checkbox at the left and quantity box at the right for the number of seats you'd like to reserve:
*
Event Description
Quantity
2010 Phase 2 Players Retreat -- US$600
I prefer to enroll by check: I'm enclosing a check or money order, made out to "Ultimate Lifestyle Academy," for the total expression of Appreciation shown above.
I prefer to enroll using my credit card (please check one):
Security Code (3-4 digit on ront or back of card) _____________________
Authorization:
I authorize The Ultimate Lifestyle Academy to charge my credit card as specified above for the 2010 Phase 2 Players Retreat and amount specified above.
_________________________________________________
(please sign your name above)
Here are my details:
Name:
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(No P.O. Boxes Please)
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