Amazing Relationships Presenter Form

First Name *

Last Name *

Email *

Paypal Email

Your PayPal address where we will send your affiliate commissions (if you opt to participate in Misa's affiliate program)

Phone *

Website/URL

Title of Your Talk *

Outcomes/benefits-oriented title

Interview Questions and/or Bullet Points (3-4) *

Name of Free Gift

Free Gift Description

Short Free Gift URL

List Size *

Bio (50-100 words) *

Headshot Photo (JPEG or PNG)

Maximum file size: 5MB

If you have difficulty uploading your photo, email it (clearly identified) to ad***@ne****************.com.

Date for your 1st promotional email (solo email to entire list)

The promotional period is January 28 through February 11. The actual summit is February 12 through 16. (Closer to launch is preferred.)

Date for your 2nd promotional email (solo or newsletter)

The promotional period is January 28 through February 11. The actual summit is February 12 through 16. (Closer to launch is preferred.)

Optional: I wish to participate in the affiliate sales program for Misa's product(s) being sold through the Event..

Yes