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Focus-23: Payroll Deduction

Thank you for deciding to join the Focus-23 program. Please fill out the following payroll deduction form to initiate payment and registration. Your initial payment will be deducted from your paycheck within 30 days.

Identifying Information




Address and Phone









Payments and Discounts


Please indicate the amount of your payment by selecting one of the radio buttons below. If you are eligible for any discounts, you must also select one or two of the check boxes below the payment amounts.

Note that the full cost of the program is $2125, but if you pay in full with credit card the price is reduced to $2025.