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Complete your
registration
Please complete the program registration form below. Upon registration & payment, members receive:
Access to
Mentorship Program
Standard
6 Month
$1,500
Standard
12 Month
$3,000
User
Information
User
Information
First Name
Last Name
Email
Confirm Email
Phone
Address
City
State
Country
ZIP
Platform ID
Payment
Information
Payment
Information
Membership Type
Mentorship - 6 Months $1500
Mentorship - 12 Months $3000
Credit Card Type
Visa
Mastercard
American Express
Discover
Credit Card Number
Expiration Date
1
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12
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
CVV Code
I understand this program registration fee is non-refundable.
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