Subscription Application Form


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Secure Subscription Form

We respect your privacy. The personal information requested below is for use in processing your credit card, which is done with secure encryption. We never reveal, share, or sell member information. For complete details see our Privacy Statement.

Customer Information

* = Required - Must match credit card billing address!

First Name [ required ]
Last Name [ required ]
Company
Address Line 1[ required ]
Address Line 2
City [ required ]
State [ US & Canada ]
State/Province [ All other Countries ]
Zip/Postal Code [ required ]
Country [ required ]
Your E-mail Address [ required ]
Phone or Fax Number [ required ]

Shipping Information

Shipping same as billing address

Ship To First Name [ required ]
Ship To Last Name [ required ]
Ship to Company
Ship to Address Line 1[ required ]
Ship to Address Line 2
Ship to City [ required ]
Ship to State [ US & Canada ]
Ship to State/Province [ All other Countries ]
Zip/Postal Code [ required ]
Ship to Country [ required ]

Subscription Options

Subscription Plan: We take Visa/MC/Amex/Discover Or you can use Paypal Paying via Paypal does not allow for the quartly or the month to month plan the and there is no 30 day trial with that option. If you prefer to pay via Paypal you can get the $97.00 1 year membership including the fantastic bonuses described the panel to the right. This membership is non-reoccurring so you will need to renew at the end of your year. Please scroll to the bottom of this page for the PayPal button.	Limited Time - $5 one month Trial Offer We remove any of the risk by offering you a 30 day trial for only $5! You get full access to our community for 30 full days. If you cancel by the end of the 29th day you won't be billed any further. That's as fair a deal as you can get. Come on in and learn powerful Skills for Life Success and become a member of this supportive community. 1 Year only $97.00 BONUS: This option includes a 45 minute FREE coaching session with Patricia or Rick (a value of $150.00) plus FREE lifetime membership to our Lifetime Learning Center, (a $79 value) for a total bonus value of $229.00! 3 Month ($49.00) automatic renewal- Your credit card will be charged automatically every three months. Cancel anytime by logging into your account or by e-mail. 30 Day Trial ($5) After the trial period, your card will automatically be charged $19.95 per month. It is your responsibility to cancel by logging into your account or by e-mail.

Choose LOGIN Name [ required ]

Choose PASSWORD [ required ]at least six characters long, using alphas and numbers, no spaces.

Confirm PASSWORD [ required ]

Payment Information

Payment Method [ required ]
Credit Card Number [ required ]
Credit Card Security Code [ required on (MC/Visa/AMEX) ? ]
Expiration Date [ required ]	/
Name on Credit Card [ required ]
Is this a Renewal?
Do you wish to receive email alerts?
<<< Please Check The Box to acknowledge that you have read and understood our terms of use.

NOTE: It can take up to a minute to process the credit card information and obtain approval. Please do not press the submit button multiple times - doing so could cause double billing.

JUST A REMINDER: Due to the way PayPal works we can only offer the 1 year $97.00 membership without the 30 day trial. However this plan does include the great bonuses of coaching and FREE membership in our Lifetime Learning Center, a total value of $229 in bonsus alone, pluse 1 year of membership to our community, that's a great deal!
If that works for you and you want to use PayPal click below and you're on your way . . .

JOIN THROUGH PAYPAL

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