Online Event Registration

All information except the second address line and comments are required. We want to be able to contact you with any unexpected updates or changes that might occur . We will not share any of your information with anyone.

If you are registering for more than one person please enter the additional names in the comments section. Thanks!

For groups of five or more please call 816-679-4616 for group rates.

Select Event:	Firewalk ONLY $140 ($155 after Oct. 10th) Firewalk & Dinner (Vegan)* $165 ($180 after Oct. 10th) Firewalk & Dinner (Vegetarian)* $165 ($180 after Oct. 10th) Firewalk & Dinner (Grass Fed Beef)* $165 ($180 after Oct. 10th)
	* PLEASE ENTER ANY FOOD ALERGY INFORMATION IN THE COMMENTS SECTION BELOW
First:
Last:
Address:
Address:	(Apt., Suite, #)
City:
State:	Zip:   (12345-6789)
e-mail:
Phone:	(XXX-XXX-XXXX)
	How did you hear about the Firewalk? Starfield Wellness Education Radiant Health Weston Red Barn Farm The Pitch Evolving Magazine Other If Other, please indicate. Thanks
	Payment Information:
Card Type:	Visa  MasterCard
Card Name:
Card #:
Exp Date:	(MMYY)

Enter comments, questions or food allergies/sensitivities here:

* We will not share your name, phone or e-mail address or other private information with anyone.
 
Please wear weather-suitable clothing that can be kept away from the fire (pants to roll up, or shorts/skirts). Checks will not be held. Waivers will be required. Rain or shine, let's hope for shine! See you there.