Name *

First Name

Last Name

Phone *

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I wish to pay for my seminar with a post-dated check. I attend a seminar before my money is available. I am attending this seminar:

March 26-28, 2021 - BGI 2: Bay Area, CA (Eric Rubin, DC)

May 14-16, 2021- BGI 2: Atlanta, GA (Liliana Warner, DC)

June 18-20, 2021 BGI ANIMAL 1: Lambertville, NJ (Jackie Manfre, DC & J. Kate Wetterlin-Duga, DC)

July 23-25, 2021 - BGI 1: Kansas City, MO (Marcia Segura, DC)

Aug 6-7, 2021 - BGI Osseous: Atlanta, GA (Liliana Warner, DC)

Aug 27-29, 2021 - BGI 3: Bay Area, CA (Eric Rubin,DC)

Sept 3-5, 2021- BGI 3: Atlanta, GA (Liliana Warner, DC)

Oct 8-10, 2021 BGI ANIMAL 1: Atlanta, GA (Jackie Manfre, DC & J. Kate Wetterlin-Duga, DC)

Nov 5-7, 2021 - BGI 1: Bay Area, CA (Eric Rubin, DC)

Date check is given to the liaison *

MM

DD

YYYY

Date BGI can cash the check *

MM

DD

YYYY

I understand that I am responsible for the full amount of the check on the date agreed upon above *

I understand

I understand that if my check doesn't not clear on that date, I will be invoiced for the full amount of the check plus an ADDITIONAL $100 Fee *

I understand

I understand that the purpose of this agreement is to allow me to attend the seminar before I have the funds to pay for it. It is in good faith and I will not abuse it. *

I understand

I have read and understood the above agreement on post-dated checks. I will do everything in my power to have the funds available on the date agreed upon. I will contact BGI HQ with any issues ASAP. *

I promise