ATTENDANCE CONFIRMATION FORM & 1ST PAYMENT

Congratulations on choosing to join CG Select.
Please complete the form below in its entirety.
This $1,500 payment serves as the 1st installment (12 total) of your CG Select membership.

First Name*

Last Name*

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Phone*

Street Address 1*

Street Address 2

City*

State*

Postal Code*

Country*

Card Type*

Card Number*

Month*

Year*

The Collective Genius	Amount
Deposit	$1,500.00

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