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THE BEST OF THE BEST WORKSHOP
Application

 

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First Name

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Last Name


 

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Company Name

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Address


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City


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State


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Postal/Zip Code


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Business Phone


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Fax


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Home Phone (Emergency Only)


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E-mail Address



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Birth date (mm/dd/yy)
 

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Broker-Dealer

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Years of Experience

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How did you hear about us?


I will be attending:

______ October 1 in Seattle           _____  October 5 in Atlanta       _____  October 6  in  Orlando

______ October 7 in Baltimore      _____ October 8  in Boston        _____   October 9 in  New York


 

 

 

 

 

Any reproduction, presentation, or commercial use of the concepts, strategies, methods, materials, and all the other trademarks, copyrights, and intellectual property of Million Dollar Producer, Inc., is prohibited without specific written permission from Million Dollar Producer, Inc.

"I hereby apply for acceptance into Million Dollar Producer's 'Best of the Best' Workshop. In doing so, I commit myself to full participation in the program. I acknowledge that all of my decisions and actions and the consequence of such decisions and actions, whether made in the context of this program or not, are entirely my own responsibility.
I enclose the non-refundable registration fee. I am aware that  my registration fee is non-refundable. I understand that it is my responsibility to handle my own travel and travel-related expenses and that the sessions are set and have no make-up date. In the event of an emergency, Million Dollar Producer reserves the right to re-schedule and/or substitute the session."

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Signature

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Date

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Name on Credit Card


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Credit Card Number


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Expiration Date


I ________________________________________________________ hereby authorize Million Dollar Producer, Inc., to charge

the credit
card account number above in the amount of $ 299

Cardholder Signature:_________________________________________________________________________

Please complete and fax to Million Dollar Producer ~ 916-780-0645

Copyright © 2009 Million Dollar Producer, Inc. All rights reserved.