A follow up text message will be sent to you shortly!

Intake form needs to be completed and paid at least 1-week prior to proposed trial start date

I am the *

First Name *

Last Name *

Phone *

Email *

Trial Type of PEP Interested In *

Trial Time Interested In *

School Type *

Input All Grade Levels To Service *

School *

Address *

City *

State/Province *

Zip/Postal Code *

Trial Overall Anticipated Number of Participants *

PEP Anticipated Trial Date *

PEP Trial Class Anticipated Start Time (1 hour maximum time) *

PEP Trial Class Anticipated Secondary Start Time (1 hour maximum time) *

*Upon contract signing this amount will be credited back to your account. *

PEP Trial

$250

I Consent to Receive SMS Notifications, Alerts & Occasional Marketing Communication from company. Message frequency varies. Message & data rates may apply.