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TEAM Certification and growth membership

Entire OFFICE TEAM Certification Membership

$297

** TWO month FREE - as a PIERS member **

** Please fill out WHILE ON THE PHONE with Dr. Shetlin **

See the footer for all the access you receive with your first year membership

** Enter FIRST PAYMENT DATE on the day of your choosing, 60 days or less from today **

Payment Information
Description	One office - multiple members
Payment Amount	Frequency When will monthly payments start? How long will payments go? How many monthly payments?

Contact
First Name*
Last Name*
Email*
Verify Email*
Number Of Staff/Team Members
Names of those attending

Billing Address
Billing Address*
Billing City*
Billing State*
Billing Zip*
Billing Country*

Billing
Name On Card*
Credit Card Number*
Card Expiration Date*	/
Card Verification Code*	what's this?

First Name on Account*
Last Name on Account*
Bank Name*
Routing Number*	what's this?
Verify Routing Number*
Account Number*
Verify Account Number*

Check To Confirm

Please check the box to confirm you want to schedule Monthly Payments and not be charged at this time.

Enter /Your Full Name/
to Sign and Authorize.

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I affirm that the information entered on this form is true and correct.

Access for the entire office On-Site and Remote working TEAM to train, learn, test and certify individually or together.

Full access to the private training website

Full access to the private CERTIFICATION training and testing website

FREE seminars attendance (see website and emails)

Accountability calls and training calls

Marketing assistance (especially once certification is complete)

HWS & Whiplash Group
10462 S. Redwood Dr South Jordan, UT 84095
(801) 867-9714

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