Enterprise Membership - Focus and Flourish

Workshop History*
- I am a new customer
- I am an existing customer
How did you hear about us?*
Consolidator/ Group Name*

If buying on behalf of more than one hospital, please enter the name of your group.
Administrator First Name*

Name of purchaser.
Administrator Last Name*
Billing Address 1*
City*
Billing Address 2
Province/State*
Country*
Work Phone*
Email*
To comply with CASL (Canada's Anti-spam Legislation), we now require your express consent to email you about upcoming workshops. Please checkYES and E-sign here if you consent. By checking YES, You can opt out at anytime by sending an email to: info@focusandflourish.com
Do you consent?
- Yes