The Road to Building Wealth Tour
Name
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First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
What city will you attend? ( ONLY 50 spots are available in each city)
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May 17-18, Chicago, IL
July 19-20, Atlanta, GA
August 9-10, Raleigh, NC
September 20-21, Washington, DC
October 4-5, Houston, TX (New Date)
October 18-19, Detroit, MI
General Admission or VIP
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General Admission, $800
VIP, $1600
How did you hear about this event?
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Marquita Leonard
Charles Jenkins
Do you currently have a business?
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Yes
No
If so, what is your business name?
If you do not have a business, are you interested in starting one?
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Yes
No
If you do have a business, what type?
Do you have a will?
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Yes
No
Do you have a trust?
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Yes
No
Do you have business credit?
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Yes
No
Do you need credit restoration?
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Yes
No
What is your credit score?
*
Would you like to add a spouse or friend?
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Yes
No
Provide name of spouse or friend
Are you ready to process your payment today? If you are not, please DO NOT submit this form until you are ready to make your payment.
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Yes
No
Signature
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Date
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Month
-
Day
Year
Date
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