First Name: 
Last Name: 
Dob (mm/dd/yy): 
Address: 
City, State ZIP: 
Daytime Number: 
Evening Number: 
Cell Number: 
Email Address: 
Are you a Member?: 
Ladies In Stride Team: 
Are you a LIS Captain?: 
Emergency Contact- Name and Number: 
How did you hear about our Retreat (person/event)?: 



Body Massage
Reflexology Foot Massage
Facial
Manicure
Pedicure

** While in the Spa area, please enjoy the Steam Room **

LIS ONLINE PAYMENTS

* All online registrations will incur a $7.50 processing fee. To avoid this fee, you may mail your Money Order or Cashier's Check to:

Ladies in Stride, Inc.
PO Box 1016
Tucker, Ga 30085

   Payment Options for Members $100 Deposit Only (Deposit is due on or before 12/31)
$100 2nd Payment Only (Payment due Feb. 15)
$85 Final Payment Only (Payment due on or by Apr. 15)
$285 Full Payment for L.I.S. members - This includes your deposit

   Payment Options for Non-Members $100 Deposit Only (Deposit is due on or before 12/31)
$100 2nd Payment Only (Payment due Feb. 15)
$100 Final Payment Only (Payment due on or by Apr. 15)
$300 Full Payment for Non-Members - This includes your deposit

   Payment for Spouses & Male Guests (The Love of Your Life Session) $25 Payment for Spouses & Male Guests (Love of Your Life Session)  Nbr:   Name(s):

   Payment for Spouses & Male Guests (to attend our LA City Tour - space is limited) $70 Payment for Spouses & Male Guests (to attend our LA City Tour)  Nbr:   Name(s):

  As a participant of L.I.S. 5th Total Health & Wellness Hollywood Retreat, if I should choose to participate in any or all of the activities planned by L.I.S. Inc., I hereby for myself, my heirs, executors & administrators, do waive & release any & all rights & claims for damages & injuries against L.I.S. Inc., board members, organizers, sponsors & assigns for any & all claims of liability. I am also aware that some of the photos & videos taken during this retreat may be used to promote future L.I.S. Retreats and help to increase membership.