ADHD Atlanta 6 Week Class Online Payment

ADHD Atlanta's Mindfulness Groups review mindfulness concepts and learn new mindfulness practices

Instructions for Registration and Online Payment:

Please use this form to begin the registration and payment process. Completing this form does not automatically reserve a spot in the group. You should use this form after arranging for the group with ADHD Atlanta. If you have any questions, please email us or call 404-351-2008. Once you submit this form, you will be redirected to pay via our online payment partner NMI.com

Astericks (*) indicate required fields.

1 Start 2 Complete

Participant Information

Name *

Date of Birth

Month

Day

Year

Parent/Guardian

Parent or guardian if participant is under the age of 18

Payment Details

Person who will be submitting payment

First Name *

Last Name *

Address *

Address 2

City *

State *

Postal Code *

Phone *

A phone number where we can reach you if there is a problem or question.

Email *

An email where we can reach you if there is a problem or question.

Payment Amount * $

Agreement *

I agree and consent

You agree and consent to participation and the terms and conditions.

Search form

ADHD Atlanta 6 Week Class Online Payment

Instructions for Registration and Online Payment: