Family Reunion 2014Mega Camp 2013 Combo Registration Form

Please complete all fieldsand return to the Family Reunion Team via email () or fax (512-233-1769) by3/15/13. Any forms received after this date will NOT be processed. An email confirmation will be sent to the address provided on this form within a week of processing. If a confirmation email is not received by 4/1/2013, please email .

ALL FIELDS MUST BE COMPLETED.

Please select ONE option:

Option 1: Registration price of $777 includes Mega Agent & Mega Tech Camps 2013 and Family Reunion 2014($77.70/month)

Option 2: Registration price of $499 includes only Family Reunion 2014 ($49.90/month)

TEN MONTHLY PAYMENTS* (MARCH 2013 – DECEMBER 2013)

*A one-time $5 payment plan service fee will be charged immediately upon receipt of this form. The first monthly payment will begin March 20, 2013.

-or-

PAY IN FULL TODAY

Attendee Information:

First Name: / Last Name:
Email Address: / Phone:
Address/City/State/Zip:
Market Center #: / Market Center Name:
Is this attendee a Mastery Coaching Client? / NO YES / Mastery Coaching Clients automatically receive a complimentary registration to Family Reunion and payment plan forms willNOT be activated for them.
Guest / Non-KW Associate
If checked, please let us know who this is a Guest of:

Payment Information:

CARD TYPE: / VISA MASTERCARD AMEX
NAME ON CARD:
CREDIT CARD NUMBER:
EXPIRATION DATE:
CARD SECURITY CODE
(VISA/MC- 3 DIGITS ON BACK OF CARD, AMEX- 4 DIGITS ON FRONT OF CARD

Terms & Conditions

I authorize Keller Williams Realty, Inc. to charge my credit card per the above Registration Fee(s) for the Keller Williams Events Selected. If I selected the payment plan option, a one-time $5 service fee will be immediately charged upon receipt of this form and the monthly payments will automatically be charged on the 20th of each month beginning March 20, 2013 until December 20, 2013. Failure to make any monthly payment within 30 days of the monthly due date (20th) will result in automatic termination of registration. Upon termination, refunds will not be given and transfers or payment of any outstanding balance will no longer be accepted.

  • Payment Plans are NON REFUNDABLE, but are transferable to a new attendee if the plan is in good standing.
  • Registrants who do not attend the event(s), "No-shows," will not receive a refund.
  • Registrations may not be carried over or transferred to a future event.
  • If no registration options are selected above, this form will not be processed. ALL FIELDS MUST BE COMPLETED.
  • It is the responsibility of the registrant to notify if an event confirmation email is not received by 4/1/2013.

By signing, I fully agree to the Terms and Conditions listed above.

Signature: ______Date: ______