NDJV Program Enrollment Form Name* First Last Phone*Email* Program Terms & Conditions* I understand that by submitting this form I am in effect signing and agreeing to all terms listed below• I realize that I have the option of leaving the program at any time but I must notify the center in writing 14 days prior. • I understand that I will be added to the Physician's Choice Wellness (PCW) Email List in order to be emailed information pertaining to my program participation as well as any special notices from PCW. PCW does not share email or personal information with third parties. • I understand that there will be no refund given for missing a class/clinic. • I understand that by submitting this form I am in effect signing and agreeing to all terms listed above.NDJV Price: $59.00 Your credit card will be charged automatically each month for your NDJV program. You may cancel anytime with 14 days' advance notice. Total $0.00 Credit Card American ExpressDiscoverMasterCardVisa This iframe contains the logic required to handle Ajax powered Gravity Forms.