MEMBERSHIP OPTIONS
ENROLLMENT APPLICATION
CONTACT INFORMATION / PRACTICE DETAILS (for internal use only)
MEMBERSHIP OPTIONS (+ domestic shipping & handling $18.95 – int’l rates vary)
OPTION #1 GOLD PLUS
OPTION #2 IN (YOUR) OFFICE TRAINING
$2500 now to secure your spot, $2500 to confirm date & trainer travel.
Remaining $1900 due 2 weeks prior to scheduled training.
OPTION #3 SELF-STUDY TRAINING
< BEST VALUE - YOU SAVE $12,000
< BEST VALUE - YOU SAVE $2003
< BEST VALUE - YOU SAVE $700
PAYMENT INFORMATION
Credit Card #
Card Type Exp Date
By submitting this form, you agree to the following terms: After 90 days of the Self-Study and In (Your) Office Training or, after 12 months of Gold Plus, you will automatically be enrolled in our Gold Membership at $199 per month charged to the card on file at that time. Gold Membership is cancelable at anytime.
DETERMINE WHICH
OPTION IS BEST FOR YOU...
Watch This Video NOW! >>>>>>>>
Jay will walk you through each of the 3
membership options step-by-step to help
you determine what option is best for you.
READY TO JOIN!
Complete the following Enrollment Application
-or- CALL (866) 861-3676
Exculsive Membership Enrollment Application
*** CONFIDENTIAL ***
FOR TELESEMINAR ATTENDEES ONLY!
HURRY! THIS OFFER ENDS 5PM WEDNESDAY!
1875 Old Alabama Rd #1220, Roswell, GA 30076
CALL: (866) 861-3676
100% Satisfaction Guarantee
Implement Jay Geier’s Scheduling Institute in your practice
and you’ll receive Jay’s 100% Satisfaction Guarantee!
My personal promise is that I stand behind all services and products with a 100% Satisfaction Guarantee. Remember, turning a practice around or making significant new patient improvements require commitment from both you and us. You have full commitment of myself and my entire team. YOU are our top priority!
We will always treat you with dignity and respect and expect the same
in return. Results require handling difficult issues and we will stand
behind all our clients 100%. One of our top goals for each client,
is that your time & financial investment with the Scheduling Institute
creates a favorable financial return. I guarantee it!
Sincerely,
Jay M. Geier
REQUIRED
Doctor’s Name Office Phone
Address
City State Zip
Email Address
OPTIONAL
Fax Cell Phone D.O.B.
How Many Total Staff Members Do You Have?
How Many Of Your Staff Members Answer The Phone?
Approximately How Many New Patients Do You Get Per Month?
What Is Your Approximate Annual Gross Revenue?
Total # Of Doctors In The Practice Total # Of Locations
(month & day)
