ILLUMINATE 2.0

PAYMENT DETAILS

Please complete the details below and submit the form to secure your spot for Illuminate 2.0

Week 1 begins on the the 2nd of March 2020

You will be sent a Welcome + Info Pack once payment details have been confirmed

**ONLY 2 EARLY BIRDS SPACES LEFT - USE THE CODE ‘EARLYBIRD’ FOR $300 THE FULL INVESTMENT PRICE**

Name

First Name

Last Name

Email

Discount Code

Payment option

E.g. Pay upfront and save, 3 month payment plan, 6 month payment plan or 12 month payment plan

Monthly date of payment deduction

First payment will be processed immediately then choose your payment date for the ongoing payments E.g. 15th of every month following

Name on Credit Card

Credit Card Number

Expiry Date

CVC Code

Code on the back of the card

Date of Birth

Info needed for Week 3's training

Time of Birth

Info needed for Week 3's training

Birth Place

Info needed for Week 3's training