Discovery! Programr Registration

Program Registration for Refocus

All fields must be completed even if you use N/A.

	Program Location:	Program month you will be attending:

	First Name:	Class#:

	Last Name:	Home Phone:

	Address:	Work Phone:

	City:	Cell Phone:

	State:	Email:

	Zip:	Marital Status:

	Age:	DOB:

	Roommate Preference:	Will you be staying in the hotel:

	Emergency Contact Name & Phone Number:

	Referred By:	Occupation:

	Month/Year Attended D1	Month/Year Attended D2

	Month/Year Attended D3-Mission	Month/Year Attended Spiritual

	Month/Year Attended Relationship	Is this your first time attending Refocus?

	What do you want to get out of Refocus?


A successful submission will take you to the Payment page.

Discovery One

D1 identifies the obstacles and experiences in your life that have prevented you from living a life that is REAL.

Discovery Two

D2 further develops the tools you need to get the positive results that you desire.

Discovery Three Mission

D3-MISSION uncovers your greatest assets and reveals your personal mission in life.

Site designed by DFW Web Design