Boot Camp Registration Form

Business Contact Name/1st Attendee*

First NameLast Name

Email*

example@example.com

Attendee #2

First NameLast Name

Email

example@example.com

Attendee #3

First NameLast Name

Email

example@example.com

Attendee #4

First NameLast Name

Email

example@example.com

Attendee #5

First NameLast Name

Email

example@example.com

Attendee #6

First NameLast Name

Email

example@example.com

Business Email*

example@example.com

Business Phone*

Cell Phone

Fax Number

Organization Name*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

What was the motivating factor behind your decision to register?

Roommate Information (double occupancy rooms are nonsmoking):

FemaleMale

I prefer single occupancy and am adding $350.00 to my first payment.

YesNo

Registration Options:

Small Business Boot Camp

$2,599.00 Quantity

Single Occupancy(+350 per person) for Single Occupancy

$350.00 Quantity

Kids First Too Excursion Experience Add-on(+400.00 per person) Includes lodging on Wednesday, breakfast at hotel, KFT tour, opportunity to meet DL’s, watch classes, transportation and lunch on Thursday with drop-off back at hotel around 3:00pm. (Must arrive on Wednesday.)

$400.00 Quantity

Early Enrollment Discount(-100.00) if registered 30 days before the start of camp.

$-100.00

Multi-Person Discount(-200.00) for the 2nd, 3rd, (etc.) person from the same organization at the same BOOT CAMP (one manual per club).

$-200.00

Boot Camp Graduate Discount(-200.00 per graduate) if you, personally, are a BOOT CAMP graduate.

$-200.00 Quantity

Enter coupon

Total

$0.00

How would you like to pay?*

Please deduct FULL PAYMENT from my credit cardI will mail a check for FULL PAYMENTEZ Pay Plan (I will mail in my application)

Type of Card

Card Number

Name on Card

Expiration Date

Example: 01/2021

Small Business Boot Camp Registration

Payment Method