A&H Membership: EMI Request Form

Full Name*
Email*
Contact Number*
GST Number (if applicable)
A&H Membership Fee*
Please mention the A&H Membership Fee before taxes and actuals
Paid Amount*
Mention the initial amount and other payments you may have already made
EMI*
Please mention how much do you want to pay every month towards the A&H Membership fee.
EMI Payment Date*
Please mention the date of the month for your EMI payment towards the A&H Membership fee.
Declaration:*
1. I understand that there will be 18% GST added to the total fee as per government regulations. And all the venue, food and travel expenses will be borne by me. 2. I commit to making the full payment of the A&H Membership fee and I fully understand that the EMI is a value added services provided at no interest for my convenience. 3. I am joining the Membership to Accelerate my Success and Launch my Legacy and do not have any health or medical related expectations from the program.
- I Agree