Register

When do I register? You may register after you have done the following:

1. Read the E-Book at least twice.
2. After your Doctor's appointment and you received your baseline PSA Test, Blood Profile, Vitamin D Test, and Heavy Metal Test (see E-Book - Chapter 11).
3. Your drinking 1 to 1 1/2 gallons of Alkaline Ionized Water per day (see E-Book - Addendum 5).
4. Purchased all equipment, supplements and supplies for "My 60-Day Planner." (See E-Book - Chapter 11)

Yes, I have done all the items above. Please complete the information below and send the information to cause-of-prostate-cancer.com.

Register for "My 60-Day Planner"

Please note that all fields followed by an asterisk must be filled in.

Date "My 60-Day Planner" Starts?

First Name*

Last Name*

E-Mail Address*

Street Address*

City

State/Prov

Zip/Postal Code

Country*

Your Physical Characteristics:

Age:*

Height::*

Weight:*

Before your Start "My 60-Day Planner":

1. I read E-Book

	1 Time
	2 Times
	3 Times
	4 or more Times

2. What were the results of your TESTS?
A) Baseline PSA Test Result?*

B) Vitamin D Test Result?*

C) Heavy Metal Test Results as follows:
Mercury?:*

Cadmium?:*

Aluminum?*

Lead?*

3. Have you purchased all the equipment?*

	Yes
	No

If you answered no, what equipment do you still need to purchase?

4. Have you purchased all the supplements?*

	Yes
	No

If you answered no, what supplements do you still need to purchase?

5. Have you thrown out your toxic supplies--- including but not limited to: soaps, shampoos, aftershave, lotions, shaving cream, deodorant, sunscreens and fragrance products and purchased the health alternatives?*

	Yes
	No

6. Have you ordered and received your "Blessed Herbs" kit yet? *

	Yes
	No
	Ordered but not received

7. How many prescription drugs are you taking?*

	1
	2
	3
	4
	5 or more

Have you discussed with your Doctor which drugs you can eliminate immediately (See E-Book-Addendum 6)?*

	Yes
	No

If not discuss with your Doctor.
Drugs can be very toxic to your body. Eliminating all drugs is important in reducing your toxic load. After discussing your prescriptions with your Doctor, how many drugs are absolutely necessary for you to continue taking?

	1
	2
	3
	4

How many can you eliminate?

	1
	2
	3
	4
	5

8. Alkaline Water--- Are you drinking 1 to 1 1/2 gallons of Alkaline Water with grey sea salt daily?

	Yes
	No, but I'm close
	No, haven't started

9. Exercising ---Do you exercise at least 25 minutes per day?

	Yes
	No, but at least 4 times a week
	No, but 2-3 times a week
	No, once per week
	No, not exercising at this time.

Please enter the word that you see below.

Why do I have Cancer?

Nutrition & Supplements

Traditional Methods

E-Book

E-BookChapter - Description

Communications

Products

Register

Register for "My 60-Day Planner"