The Typing Bug Mentoring Client Registration
CONTACT INFORMATION
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Date
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First Name
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Last Name
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Street Address
Address Line 2
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City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Zip Code
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Country
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Email Address
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Telephone Number (day)
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Telephone Number (eve)
Fax
BUSINESS INFORMATION
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VA Status
Aspiring VA
New VA
Existing VA
Company Name
Website
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Brief Description of Business
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How Did You Hear About My Mentoring Program?
VANetworking
Virtual Assistantville
Thomasville Townie
WTUF 106.3
Seymour Products
Flyer/Brochure
Facebook
Twitter
Business Opportunities Biz
Find Virtual
Typing Bug Gazette
Other
SOCIAL NETWORKING
Social Networks You Belong To
Biznik
Facebook
LinkedIn
Twitter
Messaging Sites You Belong To
AOL
Google Chat
MSN
Yahoo
BILLING SUMMARY
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Mentoring Package
Mentoring Package (1 Month - $30)
Mentoring Package (2 Months - $50)
Mentoring Package (3 Months - $75)
THANKSGIVING SPECIAL (1 Month - $25)
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Once the form is received, we will email you an invoice for the designated amount via paypal. Please indicate below your paypal email address. If you do not currently have a paypal account, please indicate which email address you would like receive an invoice at.
ACKNOWLEDGEMENT
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I acknowledge that any information that is disseminated to me by Deneen Wilson at Typing Bug is solely her opinion and not presented in any way as being an expert in the industry.
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