X-TremeSpeaking/Sponsors/Affiliate Form

Please provide us with your contact information in the form below and we will contact you as soon as possible.

Name	*
Company
Phone Number
Email Address	*
I am interested in the following: (Click all that apply)		Sell George Bien Products as an Affiliate Sponsor a George Bien Workshop/Seminar 3-Day X-Treme Speaker/Trainer Boot Camp Hypnotic Speaking Part 1 - includes Hypnosis Certification (when taken with Pt. 2) Hypnotic Speaking Part 2 - includes Hypnosis Certification NLP Certification Seminar for the Speaker/Trainer NLP Master Practitioner Certification for the Speaker/Trainer Teen Speaker Bootcamp Modeling Greatness! Unlimited Charisma/Persuasion Immersion Seminar! TV—Radio Interview Mastery 5-Day Hypnosis Train-the-Trainer Workshop Other
How Should We Contact You?	*	via Phone via Email
Addtional Comments
I understand that this is NOT a contract. By submitting this form, I am under NO obligation to attend any program, nor be an affiliate or sponsor a seminar/workshop.