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Registration Form
SGR
The Science of Getting Rich Seminars
Registration Form
Please print clearly
Name ___________________________________ Date ________________
Spouse/Family Member(s) [attending seminar] ______________________
Street Address: ________________________________________________
City: ________________________ State: _______________Zip : ________
Phone (H) ______________________ (W) ___________________________
Fax (H) ________________________ (W) ___________________________
Email: _______________________________ Birthdate: ________________
PAYMENT ? MASTERCARD ?VISA ?AMEX ? DISCOVER ? CHECK
Credit Card Number: _____________________________________________
Cardholder's Name: (as on card): ___________________________________
Exp. Date: ________________ Signature: ____________________________
Tuition: (US) per person X _____(# attending) (includes income
Acceleration Guide, SGR Book, Tapes,
Action Planner)
Total Amount ___________________
Next seminar is:March 23rd-25 th
Holiday Inn at Centennial Airport
7770 South Peoria Street
Englewood, Colorado 80112
Fax to:Jan Payne, Certified Facilitator, coach
303-768-8027
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