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Kevin Hogan
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Kevin Hogan
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Kevin AT KevinHogan DOT com






Kevin Hogan
Network 3000 Publishing
3432 Denmark #108
Eagan, MN 55123
(612) 616-0732








APPLICATION FORM
Professional Mentoring and Coaching Inner Circle PLATINUM Membership Application


Fill in all information, click submit at the end of the form. You will be sent a confirmation e-mail. Thank you!

All information is kept 100% private. No person aside from Kevin Hogan will view this information. Your privacy matters most to me.

First and Last Name:

Email Address:

Home Telephone:

Cell Phone:

Fax:

Street #1:

Street #2:

City:

State:

ZIP/POSTAL:

Country:

Membership is $12,000 annually or $1097 per month charged to a credit card.

By completing and submitting this form, you are entering your application for Kevin Hogan's Inner Circle Platinum Membership. by submitting your application, you agree to all terms of the membership program. Upon acceptance, your credit card will be charged $12,000 or your first installment if you choose that option. If you prefer, you may send a check upon notification of your acceptance. By submitting this application you understand and agree that there are no refunds once yur membership period begins.

Is your net worth over $400,000 or your family income greater than $85,000 annually?

Yes
No

Which of these best describes you:

Entrepreneur

Sales Star

Professional

CEO/Manager

Other

How many of Kevin Hogan's CD and DVD Programs do you own?

1-3

4-6

7+

Please briefly describe for Kevin what you do and how this coaching program and Inner Circle opportunity might help you most.

Please read this statement:
As part of the Inner Circle I understand that all conversations on the telephone or at a live event where other individuals are present are private. The intellectual property and discussion of techniques and strategies will not be discussed with anyone outside of the meeting room or phone conference.

Please type your name in the box below as your signature and agreement to the following statement: "I understand that the Inner Circle meetings are private and I will respect each person's privacy by not sharing information discussed in those meetings with anyone."

Please read this statement:
When I become a member of Kevin Hogan's Inner Circle, I understand that the membership is good for one year. I understand that with Kevin Hogan's personal written permission, I can use this fact as a marketing tool until the end of the year at which time a long term membership option will be made available to me.

Please type your name in the box below as your signature and agreement to the following statement: "I understand I need permission to use Kevin Hogan's Inner Circle name in my marketing or professional materials."

Please type your name in the box below as your signature and agreement to the following statement:
"I understand that there are no refunds but that if I were to be sick or unavailable for a conference or meeting that I can make that up at the next meeting even if it extends beyond my membership. This option is good for up to two absences in the year."

Please read this statement if you are making monthly investments into the Inner Circle:
I authorize Network 3000 Publishing to debit my card monthly in the amount of $1097 for the next 12 months. I understand that this sale is final.

Please type your name in the box below as your signature and agreement to the following statement: "I authorize Network 3000 to debit my card monthly in the amount of $1097 for 12 months I understand this sale is final and there are no refunds."

All Major Credit Cards Accepted

Payment Method:

Master Card
Visa
American Express
Discover
Check/Money Order
For Credit Card Orders:

Credit Card Number:

Expiration Date:

3 or 4 digit Security Code:


Name as it appears on card:


Total to Charge Today :

If the Billing Address on your credit card statement is different from the one you gave above, please type it below.

If you'd prefer not to send your credit card number over the internet, you can call our headquarters, 24 hours per day at

(612)616-0732.

Have all of your ordering and credit card information ready to leave on our secure voicemail system.

If you do not have MasterCard, Visa, Discover or American Express, you can still register from this page! Just fill out the appropriate sections and submit this form. Then simply mail a check or money order(payable to: Network 3000) to:

Network 3000,
3432 Denmark Ave. #108
Eagan, MN 55123.

Your order confirmation will be sent upon receipt.

You will be contacted by email regarding your acceptance into this program. Kevin Hogan retains the right to turn down any application for any reason prior to the beginning of the program. No charges will be made to your credit card until acceptance is complete.

Important: If accepted, your charge will appear as Network 3000 on your statement!

Fill in all information, click submit at the end of the form. You will be sent a confirmation e-mail. Thank you!



Kevin Hogan
NETWORK 3000 Publishing
3432 Denmark #108
Eagan, MN 55123 USA
(612) 616-0732




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