Wayland Conference Registration Form

AUGUST 26-29th, 2021
WAYLAND ALTITUDE CONFERENCE
THE JIMENEZ AGENCY BASE SHOP
DISCOUNT TICKET PURCHASE FORM
Andrew Jimenez

If you are with a different agency, do not use this form and please contact your Agency Owner or the individual who hired you.
If you’re committed to starting and building this business, sign up today for the Wayland Altitude Summer Conference for an early bird price of $99 (regular price: $129).
Please submit this online form to get this discounted price.

The ticket includes conference admission and two days of training. Also, your ticket allows you to have the opportunity to compete for the Wayland Incentive Trip to the Cabo San Lucas and any Hierarchy or Company Competition!
(Note: You must be registered for the conference in order to receive Double Production points towards the 2022 SFG and Wayland Incentive Trip.)
Why wait? Make a commitment today!

More information about the Altitude conference
and the Wayland Incentive Trip here:
Wayland Altitude Conference
Full Name*
First NameLast Name
E-mail*
Phone Number*
Area CodePhone Number
Name of Your Direct Upline:*
Number of people attending*
Any Dietary Restrictions or Allergies?
Please list for each person registered.
Your signature on this form authorizes The Jimenez Agency, Independent Solutions and any of its agents to charge your card for the above-selected number of tickets. Due to hotel and event negotiations, this ticket is NON-REFUNDABLE and NON-TRANSFERRABLE. Visa or MasterCard only.
Signature*
Payments are processed through Square. You may pay using any major credit card / debit card.
Square Payment Portal*
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Discount Conference Registration$99.00

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