Application Form


A. PAYING WITH A CREDIT CARD (via PayPal)
Step 1 of 2.  Please email the completed information contained on this Application (fields 1-10), below. Copy and paste into an email the below information and email to arnievargas@gmail.com.
Step 2 of 2. Pay by either clicking-on the "Buy Now" PayPal button for the program in question, or visit http://www.PayPal.com, log in, and send your payment to arnievargas@gmail.com.  


==OR==

B.  IF YOU'RE PAYING BY CHECK. 
If you're paying by check, Contact Us to obtain the Alternate Application Form to complete and be returned to us by fax or postal mail.

Once your Application Form and your payment are received and approved, you will be notified by email.

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PLEASE COMPLETE THE FOLLOWING FIELDS (1-10), AS APPROPRIATE
:

1.  NAME OF THE AJ VARGAS ENTERPRISES PROGRAM FOR WHICH YOU ARE ENROLLING:
_____________________________________________________________________.

2.  DATE(S) BEING HELD:  ______________________________________________.


3.  TOTAL COST OF PROGRAM:  ________________________________________.

YOUR PERSONAL INFORMATION:

4.  Name: ____________________________________________________________.

5.  Mobile (Or If No Mobile, Other) Phone:________________________________.

6.  Email: ____________________________________________________________.

7.  If a Men's Program, Specify Age (must be over 21):  ___________________.

8.  For lodging during a residential program, do you wish to share a room with another participant?  If so, be sure both participants list one another's NAMES on each registration form:
 _______________________________________________________________________.
 
9.  Also, to the above, if available, do you and your roommate wish separate beds or a shared bed?  (Place an "X" by your selection):

______ Separate beds     _____ One shared bed

Note:  Every effort will be made to accommodate your request, but, depending on the host property, it cannot be guaranteed.
 
10.  Any Special Requests (specify):  ____________________________
 
_____________________________________________________________. 

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Confirmation emails with further details will be sent to those registered. Thank you!!

QUESTIONS?

If you need to contact us, go to http://ajvargas.com and click-on "Contact Us" on the blue, left-hand bar at the bottom.