Greg Perry's Shortcut to Success Seminar Registeration Form
Fill out this form and FAX to 425 744 8387
If you are paying by check or money order, Mail to:
Lifestyles of Success Institute,
19221 36th Ave W Suite 106,
Lynnwood, WA 98036 - Info 425 744 5318
Info

Agent : First_________________________ Last_____________________________

JLS Office________________________MLS Office #______________

Mailing Address___________________________________________________________

City_________________________________ State____________Zip________________

Telephone ( ) ________________________________________________________

E-Mail___________________________________________________________________

Date of Seminar_______________________

Resistration Fee: $ 199.00 (Includes Sales Tax)

Method of Payment:

Check/Money Order Enclosed________ Charge________

Visa_________ MasterCard__________ American Express__________

Card#______________ ________________ _______________ ________________

Expiration Date________________ ___________________


Signature_______________________________________________________

Terms of Agreement

I acknowledge that I have read and understand and agree to the terms set forth in this agreement.

I agree to pay a fee of 20% on my next 2 closed transactions to Greg Perry at John L. Scott.
This referral fee will be dispursed through the John L. Scott Corporate office commissions department.

Referring Agent__________________________ Date___________MLS Office #________

Signature________________________________