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Name(Required)

First Last

Address

Street Address City State / Province / Region ZIP / Postal Code

Email(Required)

Phone

District Number(Required)

District Visioning Chair (full name)(Required)

District Visioning Chair (email)(Required)

District Visioning Chair Phone (US)

Phone (International)

Training Program

Annual District Renewal

Annual District Renewal-non-English speaking programs

Total

How would you like to pay?(Required)

Pay online with Credit Card

Pay by check

Payment Method

Please send your check to

International Vision Facilitation Council

PO Box 1085

Klamath Falls, OR 97601

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