Registration Form

October 12 - October 14, 2018

Hyatt Regency San Francisco Airport Burlingame, CA

One registration form per person please.  Indicates required information.

First Name:
Last Name:
Nickname for Badge:
Phone Number:
Fax Number:
*Email Address:
Special Requests / Referral:

*Privacy Statement Live Aware will not abuse or misuse your email address. This is collected for the purpose of sending confirmations/receipts and pertinent conference updates. 

(Before 9/20)
VIP Registration
(Includes all 2 Day Registration Benefits, plus: Speaker Dinner ticket, 2 signed speaker books, priority registration check-in)
Standard 2 Day Registration
(Includes access to all sessions and Exhibitor Court, Reduced hotel rate, Free Sunday morning Yoga Class, One Free Child Registration)
Standard Saturday Registration
(Includes access to Saturday sessions and Exhibitor Court, Reduced hotel rate, One Free Child Registration)
Standard Sunday Registration
(Includes access to Sunday sessions and Exhibitor Court, Reduced hotel rate, One Free Child Registration)
Saturday Night Banquet $85

Which of the following do you currently do:
Eat non GMO food whenever possible Take precautions to lessen EMF exposure
Avoid sugar or sugary foods Vaccinate on an alternative schedule
Follow a special diet {Paleo, GAPS, WAPF, etc) Do not vaccinate
Recognize Geo-engineering/ChemTrails Use non-toxic cleaners
Filter water using table filter (such as Brita) Use VOC free paint
Filter water using reverse osmosis Have non-toxic furniture
Filter water using whole house filter
Avoid fluoridated water whenever possible Avoid using Teflon pans
Avoid Wi-Fi Use glass containers instead of plastic

If you have a discount code, please enter it here:

Total Due:

By submitting the registration form, I authorize Live Alive to charge the appropriate fees. I understand all cancellations must be submitted in writing and must be received by September 20, 2018 to be eligible for a refund less a $20 administration fee. After September 20, 2018, no refunds will be issued.

1900 Jones Road, Winchester, VA 22602
Phone 540.722.7102    Fax 540.301.3536

Copyright 2018 PTF & Associates, Inc. All rights reserved.
Revised: April 25, 2018