7 Steps Retreat

First Name *

Last Name *

Address

Street Address *

City *

State *

Country *

Postal code *

Email *

Phone Number *

Are you being referred from someone else or a treatment center? *

Yes

No

Who referred you?

Are you enrolling an additional person? *

Yes

No

Select Your Enrollment Package (includes option to add a second participant): *

12 Principles On-Demand + 7 Steps Retreat — $597 (special price until January 10, 2026; returns to original price of $997 after this date)

I have taken the 12 Principles and will only be taking the 7 Steps Retreat for $497

I am enrolled in a program that includes the 7 Steps Retreat - no charge (please input your coupon code below)

I have taken the 12 Principles and will only be taking the 7 Steps Retreat for $497

I am or was enrolled in the BALM Family Recovery Program

I am or was enrolled in a 12 Principles class with a coach or treatment center

Name of Coach:

Name of Treatment Center:

Coupon Code

I agree to submit payment immediately using the following method: *

Zelle to [email protected]

ACH (write your routing number and your account number in the space provided below)

Check made out and mailed to Family Recovery Resources, LLC, ℅ Beverly Buncher, 6698 Tenth Ave N Apt 318, Lake Worth, FL, 33467

For ACH, please provide your routing number

Please provide your account number

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