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1
Name
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First Name
Last Name
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2
Date of Birth
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Date
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3
Mailing Address
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Street Address
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Afghanistan
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Liberia
Libya
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Malaysia
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Mali
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Mongolia
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Morocco
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Myanmar
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Nepal
Netherlands
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New Caledonia
New Zealand
Nicaragua
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Niue
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Northern Mariana
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Panama
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Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
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Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
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Sudan
Suriname
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eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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4
Cell Phone Number
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Area Code
Phone Number
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5
Email Address
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example@example.com
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6
What experience do you have if any in legal field?
*
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(Check all that Apply)
(a) Looking for Work
(b) Worked or working in Legal Field
(c) Currently a Paralegal
(d) In school
(e) Not Yet started
Other
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7
Are you looking to Franchise or start your own company?
*
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Note: all students must start under our company and sign a non-compete agreement for 6 months to 1 year. Upon completion of the agreement, they may start their franchise under our company or branch off and start their own. (Select One)
Just Want to work for the company
Looking to partner and open your own franchise
Looking to learn skills and start my own company
Not yet sure
Other
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8
Would you like to Join a Online Live Class, Have 1 on 1 Session, Or Study at your own pace?
*
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Select One Below
Please Select
Online Live Class
1 on 1 Session with Chinah
E-book or Online Course (Study at own Pace)
Please Select
Please Select
Online Live Class
1 on 1 Session with Chinah
E-book or Online Course (Study at own Pace)
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9
Are you Able to Start on 8/24/2025?
*
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THIS IS A 2 PART CLASS. EACH SESSION IS 2 HOURS 1ST CLASS IS ON 8/24 2ND CLASS IS ON 8/31 . (Select One)
Yes
No, I need a different date or 1 on 1 with Chinah
I want the E-book or online course(Self Study)
Not yet sure
Other
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10
The cost for the class is $500.00. A separate invoice will be send via email once your registration is confirmed. Please Select from the option below so we may determine if you are eligible for a discount.
*
This field is required.
Select One. For Multiple Select Other.
I register and attended the Credit Repair Workshop with Chinah
I took a prior class with Chinah ( Notary, Credit Repair, Tax Prep, Turo Business)
I want to take the class with one or more friends or family
Other
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11
By Submitting this registration, you agree that you would like to participate in the webinar. You also agree to be contacted about other events or promotions. We do not sell your information to any third party without your consent. I affirm that the information provided is true and correct to the best of my knowledge. I will not be able to hold Affordable Legal Help Now LLC/INC its subsidiaries, successors or assigns for any errors based on the information I have provided. (See Additional Legal disclaimer for reference)
*
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Select Yes to Agree.
Yes, I agree
No, I do not agree (This will disqualify you)
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12
Date
*
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Date
Month
Day
Year
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13
Signature
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