EC-1 Replacement Registration

EC-1 Replacement Registration

Champion team Midwest EC
Agent Name*
Agent ID*
Your current level*
Will your spouse attend?*

YesNo
Spouse Name*
Spouse Agent ID
Your SMD*
If you are already SMD and above, please choose yourself as your SMD.
Your CEO*
Referral EC cadet name*

First NameLast Name
Referral EC cadet agent ID*
Your E-mail*
example@example.com
Please make sure your email is correct. You should receive a confirmation email.
I acknowledge that this is a registration for full classes of EC-2 which will start in January 2023. I can only attend one class in EC-1 as a trial class.
New Registration *
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EC-1 Replacement Registration$200.00

Total $0.00

Payment Methods

Debit or Credit Card

Please click one of the PayPal options to complete payment and submit the form.