Mind in Motion Consulting Inc.
Online Registration Form

Your Information is secure, please read our Privacy Policy

To return to the website, close this window.

  Applicant Information
Name:
  
Age:
  
Email:
  
Phone:
  
Current Address:
  
City:
  
Postal Code:
  
Province/State:
  
Country:
  
  Background Information
Sport/Type of Work/Lifestyle Change


How did you hear about Mind in Motion?


  Payment and Membership

To complete the membership registration, please prepare a cheque or money order for a one time fee of $50.00 CAD funds made payable to Mind in Motion Consulting Inc. and mail it to:

Mind in Motion Consulting Inc.
425 - 535 Hornby Street
Vancouver, B.C.
V6C 2E8

To pay online with Paypal, first submit this registration, then return to the Become a Member page and click on the PayPal icon.

You will receive confirmation via email once your order has been processed. At that time you will receive your login information and password.


  

Thank you!


Experience the gifts... TOP