Payment for Coaching Workshop

Your credit card statement will show this payment is made to IPX Services. All payments made on this secure server will be paid to the benefit of Biofeedback Coach Workshops. You will be registered in the Coaching Workshop ($235.00 US) for Biofeedback Professionals. Please complete the credit card form.

REQUIRED CREDIT CARD INFORMATION

Coaching Workshop ($ 235.00)

First Name:	Last Name:
Address:
City:	State/Province: Zip:
Country:
Phone Number:
E-Mail Address:
THANK YOU!