Customer Onboarding - Antano & Harini

Personal Details:
Full Name*
Email*
Contact Number*
A&H Consultation Request:
Where are you coming from?
Which cities can you come to?*
- Delhi
- Mumbai
- Chennai
uP! Participation Confirmation:
Select the location in which you are attending the uP! Event*
- Delhi, 22nd - 27th April 2019 (Dates may change owing to the recent Election announcements)
- Mumbai, 5th - 10th August 2019 (Dates may change owing to the recent Election announcements)
Payment Terms:
Payment terms:
- Full payment within 60 days
- EMI of Rs. 23,260 for 12 months
GST Number (if applicable)
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

Personal Details: