Registration Registration - Wealth Building Workshop Name(Required) First Last Email(Required) Enter Email Confirm Email Mobile Phone(Required)Best Way to Contact Me: Email Phone Text Message Other Other Way to Contact MeI consent to receive communications from PSI Seminars:(Required)May include phone, email, or social media. Yes No Are you a graduate of the PSI Basic Seminar?(Required) Yes the Basic was awesome!! Not Yet! What is the highest level course you've completed?(Required)PSI Basic SeminarLife Success Course (PSI-7)Pacesetters Leadership Dynamics (PLD)Leadership Seminar (MLS/WLS)Principia/Next-10/MomentumSelect Your PSI City(Required)Select OptionCalgary, ABDenver, COHonolulu, HILas Vegas, NVLondon, UKOrange County, CAPhoenix, AZSan Francisco, CAVancouver, BCOther/UnknownHow did you hear about this workshop?(Required)Select OptionEmailFacebookFriend/RelativeGoogle SearchInstagramI attended a free workshopPSI EmployeeOtherPlease specifyWhere Would You Like to Attend? Phoenix, AZ - In Person Simulcast - Via Zoom This field is hidden when viewing the formConfidential Health QuestionnaireThis field is hidden when viewing the formDo you have any history of psychiatric disorder, been institutionalized for mental illness within the last 12 months, or undergone treatment by a psychiatrist or psychologist in the last 6 months?(Required) Yes No This field is hidden when viewing the formPlease explain any of the above marked "yes"(Required)PSI Seminars are based on an educational model, not a medical model. If you have any history of psychiatric disorder, or have been institutionalized for mental illness within the last twelve months, or have been undergoing treatment by a psychiatrist or psychologist within the last six months, it is the policy of PSI Seminars that you do NOT attend.PSI Terms and ConditionsAssumption of the Risk and Waiver of Liability Relating to Coronavirus/COVID-19The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. PSI WORLD, AND PSI SEMINARS, LLC strongly recommends vaccination prior to attending any seminars and/or indoor gathering. PSI WORLD, AND PSI SEMINARS, LLC has put in place preventative measures to reduce the spread of COVID-19; however, PSI World and PSI Seminars cannot guarantee that you will not become infected with COVID-19. Further, attending our seminar could increase your risk of contracting COVID-19. By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I may be exposed to or infected by COVID-19 by attending a PSI Seminar’s event and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at the seminar may result from the actions, omissions, or negligence of myself and others, including, but not limited to, PSI employees or staff, volunteers, and program participants and their families. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I may experience or incur in connection with my attendance at, or participation in PSI Seminars (‘Claims”). On my behalf, I hereby release, covenant not to sue, discharge, and hold harmless PSI, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of PSI World or PSI Seminars, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any PSI Seminars program. I have read, understand, and agree to the Assumption of the Risk and Waiver of Liability Relating to Coronavirus/COVID-19PSI ADVANCED SEMINAR TUITION POLICYTuition must be paid in full prior to attending. All tuition payments are non-refundable and must be utilized within 12 months of the date of registration or will be forfeited. Changing your attendance date within 30 days of your scheduled class is subject to a $1000 fee. In the event you are unable to attend, you can make a one-time transfer of the full amount of your paid tuition to another student. Transferred funds will be converted to a non-refundable single-use voucher that can be applied to any full price seminar purchase. Transfer voucher must be redeemed within 30 days or will be forfeited. Class size is limited, and payment in full does not guarantee a seat in the class. If the class is at capacity you will be placed on a waitlist. Once your registration is complete a representative will contact you to confirm your status. CANADA: I understand that PSI Seminars Canada is governed by the Provincial Consumer Protection Acts. Furthermore, I understand that my payment for any PSI Advanced Seminar is non-refundable and must be utilized within 12 months of the date of registration or will be forfeited. I have read, understand, and agree to the PSI Tuition Policy and all PSI Terms and Conditions Registration DetailsPSI Relationship Workshops(Required) Wealth Building Workshop (November 11-13, 2022) Total Registration Code Name of Spouse/Parent Who You Are Attending With(Required)Intention Special: Is your spouse joining you?(Required) Yes No Is your spouse a PSI graduate?(Required) Yes No Cardholder Name(Required)Credit Card(Required) EmailThis field is for validation purposes and should be left unchanged. Δ Privacy We will not share information that you provide us (including e-mail addresses). Security All personal information you submit is encrypted and secure.