Register NOW for Your Gems Family Members’ Retreat, Spring 2019
STEP 1: Complete contact & attendee information requested below
Primary Doctor Attending:_________________________________________________ Spouse Attending: _________________________ Additional Doctors Attending:_______________________________________________________________________________________ Team Members Attending __________________________________________________________________________________________ City: _______________________________________ State:_______ Primary Doctor’s Cell Phone:_______________________________ Email Address for Confirmation Email ____________________________________________ Today’s Date ____________________
STEP 2: Fill in the five yellow cells
GG12 Other GIC
Gold Member Full Fee
Gold Register 1/1/19 to 1/31/19
Gold Register by 12/31/18
Platinum Member Full Fee
Platinum Register 1/1/19 to 1/31/19
Platinum Register by 12/31/18
Line Totals
Fill in # of Doctors and # of Non-Docs then Enter Total For Docs & Team Based Upon Your Membership Level and the Date by Which You Register
#
Members
Doctors
NC* $1497 NC* $1297
$1197
$997 $797
$897 $697
$897 $697
$697 $497
$597 $ $397 $ Total $
$997
Non-Doctor Team & Spouse
____ Thursday Keynote and GG12 Certified Coaches Presentations ____ Thursday Evening GG12 REUNION CELEBRATION Dinner ____ Friday GG12 Doctor and Spouse Mastermind Session ____ Friday GG12 Team Members’ BREAKOUT Mastermind Session ____ Friday Evening Gems Family Retreat Dinner ____ Saturday Gems Family Members’ Doctor & Spouse Mastermind Session ____ Saturday Gems Family Team Members’ BREAKOUT Mastermind Session STEP 3: Enter into each line, the TOTAL NUMBER attending EACH event
Please enter any special dietary needs here ____________________________________________________________ Upon registration, your tuition will be charged to your credit card on file. After registering for the event, you will receive a confirmation which will include a link to book your room(s) in the event hotel at our group rate if space within the Gems group block remains available. *GG12 & GG12 Alumni Members credit card will be charged a $200.00 REFUNDABLE Deposit, to help us properly plan for meals and retreat space. The FULL $200 will be REFUNDED the week after you ATTEND the retreat (or if you Cancel 30 days Prior to event) STEP 4: Fax completed form (or see Online & Phone registration options in YELLOW HIGHLIGHT below) In “Think and Grow Rich” Napoleon Hill introduced us to the power of the mastermind. The amazing synergistic power of the whole is far greater than the sum of the individual parts. Members will have a chance to present the one HUGE BREAKTHROUGH that has helped their practice to achieve enormous gains in profitability, and the one BIGGEST CONCERN/PROBLEM with which they’d like the group’s input. I have been a participant in business mastermind sessions for the last 16 years. I can point to multiple times when that participation led me to changes or improvements that have been directly responsible for making me a multi-millionaire. This portion of our Gems Family Retreat should prove to be a very powerful and profitable benefit of your Gems Insiders’ Circle Membership.
Presented by Dr. Tom Orent, Gems Insiders’ Circle & 1000 Gems Seminars SM Complete & Fax this Form to: 1-508-879-2468 OR REGISTER ONLINE at www.InsidersCircle.com Click on the ATLANTA 2019 Banner at top left of home page or Call 1-888-880-GEMS (4367) Outside USA & Canada 001-508-872-0066
Approved PACE Program Provider FAGD/MAGD credit. Approval does not imply acceptance by a state or provincial board of dentistry or AGD endorsement . The current term of approval extends from 1/1/2018 to 12/31/2021. Provider ID #210991
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