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Radical Business Intensive Registration Form - Pay What You Can

Name
First Last
Phone (cell if you've got one):
Website
Email
What's your twitter handle?
Which city will you be attending the workshop in?
What is the name of the person who told you about this workshop? (we like to say thank you!):
Please send us a good headshot photo of you that we can put on the page for this workshop.
Please send us a paragraph or two bio/story of yourself to help us and the other participants get to know you
I understand that this is a Pay What You Can event. I will attend the entire event and then decide what I want to pay at the very end.
- Yes
- No
For more ideas on the whole pay what you can model go to: http://theradicalbusinessintensive.yolasite.com/pay-what-you-can.php
I understand that I am being asked to pay with FOUR cheques. One payable immediately (or cash) and the second, third and fourth cheques postdated for anywhere up to a year - for any amounts I choose (based on the value I got and my ability to pay). No pressure. No catch. No funny business:
- Yes
- No
http://theradicalbusinessintensive.yolasite.com/pay-what-you-can.php
I understand that there are limited spaces, so I want you to know that . . .
- I am 100% sure I'm coming, for sure. I'll be there.
- I am 90% sure I'm coming. I really want to.
For more ideas on the whole pay what you can model go to: http://theradicalbusinessintensive.yolasite.com/pay-what-you-can.php
I understand I need to make a $100 payment to reserve my spot and that my attendance is NOT confirmed until this is received.
- Yes
- No
To read the cancellation policy go here: http://theradicalbusinessintensive.yolasite.com/cancellation-policy.php
Is there anything else you'd like us to know or to ask us before the event?
How would you like to pay for your weekend?*
- Pay What You Can + $100 Deposit: You pay with FOUR cheques - or cash - one payable immediately (or cash) and the others post-dated up until a year from the event for any amount you like. Really. No catch. No pressure. No funny business. No amounts to small or too large. There is a non-refundable $100 deposit because I've found it's so easy for people to no show on an event they've never paid for. You feel me. If even $100 is a stretch - you won't be turned away - just email me and we'll work something out.
This is your $100 deposit to confirm your attendance at the weekend
Total
$0.00
Credit Card

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
Billing Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country