Café RE Membership Registration

Get access to the Recovery Elevator community, Café RE!

If you are a returning member, do not fill out this form. Please email kate@recoveryelevator.com to reactivate your membership.

First Name *

Last Name *

Email Address *

Phone

Organization

All transactions are secure and encrypted.

First Name on Account *

Last Name on Account *

Card Number *

CVV

Expiration Month *

Expiration Year *

Address 1 *

Address 2

Billing Country *

Billing City *

Billing State *

Billing ZIP Code *

When was your last drink? (MM/DD/YY)

How old are you?

Gender?

How did you hear about Cafe RE?

What city do you live in?

What state do you live in?

What country do you live in?

Please provide your name as displayed on Facebook so we can match your sign up to your account.

I accept the Terms and Conditions