Name *

First Name

Last Name

Phone *

(###)

###

####

DOB *

MM

DD

YYYY

Company Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Membership Options *

Option 1. Annual membership payment of $550+GST ($632.50 inc GST) Annual membership fee is paid on acceptance of your application. Due every year on the same date. You are required to attend on a weekly basis. An invoice will be emailed out on acceptance. This payment is non-refundable should you leave the group for any reason. Option 2. Monthly payments of $50+GST ($57.50 inc GST) Paid on acceptance of your application. You are required to attend on a weekly basis. We recommend you commit to this as you are liable to pay the required amount each month, regardless of your attendance. You are committed to a term of 12 months. All payments are non-refundable.

Option 1 - Annual

Option 2 - Monthly

Agreement

By submitting this request for enrollment, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a member, any false statements, omissions or other misrepresentations made by me on this request for enrolment form may result in my expulsion from Synergy Networking. I understand that if my membership payment is not received within 7 days of the due date, a late-payment penalty of 25% of my monthly subscription will be applied. I acknowledge that timely payments are essential to maintain my membership and participation in Synergy Networking, and I agree to adhere to the payment schedule to avoid any additional fees. By clicking and submitting this agreement you agree to all our terms and conditions.

I agree to all terms and conditions