You can register using MasterCard or Visa through secure fax at:
Toll Free Number (800) 617-4615 or by mailing this completed form using
credit card or check.
Make check payable to Lifestyle Management Associates Inc. and mail to:
Dr. Jane Pentz
111 Grove Street, Suite 1
West Roxbury, MA 02132
First print completed form. Sign the form, then Fax or mail completed form
to address above.
Please include check if applicable.