Mastermind #2

1
Name
First Name
Last Name
2
Which email address was this form link sent to?
example@example.com
3
Cell Number for Morgan to Call re: Registration
4
Are you attending?
Yes
No
5
Attendee Date of Birth
Date
Year
Month
Day
6
Spouse or Additional Attendee Name
First Name
Last Name
7
What are your top concerns, stucks, or areas of improvement going into Q3 and Q4?
Clarifying Your Vision for 2024 and beyond
Hiring and Building a Team for Growth and Autonomy
Eliminating Dependence on 3rd Party and OTC
Adding Locations and Scaling
Incorporating Supplements into your Practice
Earning Passive Income in Audiology without more people problems
I want to become a marketing master
8
Will you be participating in the pre-Mastermind Dinner on the evening of October 25th?
YESNO
9
Have you secured tickets to the Tinnitus and Cognitive Processing Disorder Event (audiologyneuroscience.com) for your entire team?
YESNO
10
AUDIO AND VIDUAL RELEASE AND WAIVER

Consent. By signing this form, I acknowledge, understand, and release that:

1.  The above named party hereby consents to the use by the Company, its authorized
representatives, assignees, subsidiaries and licensees of his/her name, photo, likeness,
image , handwriting, testimonial, video and/or sound recording in any media now
known or hereafter devised (collectively referred to herein as “Information”), and to
allow the Company to record, reproduce, used exhibit, broadcast, and publish derivative
works of the above named party, to promote or publicize the Company’s businesses.

2.  The above named party also hereby grants a perpetual, worldwide and irrevocable
license to the Company to use the Information in any manner or media, including, but
not limited to, reproduction, sale, exhibition, copying, broadcast, and distribution of the
Information.

3.  The above named party has read this Release and Waiver, and understand its contents
and intend to be legally bound hereby, for good and valuable consideration, receipt of
which is hereby acknowledged.

4. The above named party forever releases and agrees to hold harmless the Company from and against any and all claims arising from the use of such images and information.

5.  If any provision of this Agreement, or any portion of it, is held to be invalid and
unenforceable, then the remainder of this Agreement will nevertheless remain in full
force and effect.
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Consent for Training, Waiver of Liability, and Audio/Visual Release
Clear
Should be Empty: