Education Club Sign Up Form

EastPay Education Club Registration Form

EastPay's Education Club has gotten even better! Our pre-paid club allows you to register for multiple programs at a discount of up to 33%! The points offered in this package may be used from January - December of the year purchased by any of your staff members in any combination of half-day programs, full-day programs, and/or eligible teleseminars and web conferences, up to the point equivalent of the package that you purchase.

Organization Name*

Sign Up Date*

Contact Name*

First Name

Last Name

Billing Address*

City

State

Zip Code

Email*

Work Phone*

Education Club Year (choose one)* 2011
2012
2013
2014
2015

Education Club Level* Silver Level: 8 points ($600)
Gold Level: 15 points ($975)

Payment Method* Please Invoice Me (Invoice will be sent to address above)

	EastPay Education Club Registration Form EastPay's Education Club has gotten even better! Our pre-paid club allows you to register for multiple programs at a discount of up to 33%! The points offered in this package may be used from January - December of the year purchased by any of your staff members in any combination of half-day programs, full-day programs, and/or eligible teleseminars and web conferences, up to the point equivalent of the package that you purchase.
	Organization Name*	Sign Up Date* Month Day Year
	Contact Name* First Name Last Name	Billing Address* City State Zip Code
	Email*	Work Phone*
	Education Club Year (choose one)* 2011 2012 2013 2014 2015	Education Club Level* Silver Level: 8 points ($600) Gold Level: 15 points ($975)
	Payment Method* Please Invoice Me (Invoice will be sent to address above)