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:
Organization:
Address:
City:
State:
Zip:
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. 

Registration
  Early Bird
(Before 6/30)
Regular
(Before 9/20)
VIP Registration
(Includes all 2 Day Registration Benefits, plus: Speaker Dinner ticket, 2 signed speaker books, priority registration check-in)
$160 $200
Standard 2 Day Registration
(Includes access to all sessions and Exhibitor Court, Reduced hotel rate, Free Sunday morning Yoga Class, One Free Child Registration)
$110 $125
Standard Saturday Registration
(Includes access to Saturday sessions and Exhibitor Court, Reduced hotel rate, One Free Child Registration)
$65 $75
Standard Sunday Registration
(Includes access to Sunday sessions and Exhibitor Court, Reduced hotel rate, One Free Child Registration)
$65 $75
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
Other

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    www.liveaware.com

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