Elite Sport Psychology Group

 

A. PERSONALIZATION


Note: For those individuals applying for the Video Channel category only, complete the areas marked with the red asterisk.

 

1. Name to appear on all documents.
First Name: *
Middle Initial (if any):
Last Name: *
School/Company: *
 
2. Education Designator next to name on business card.



  
 
Mailing Address 1: *
Mailing Address 2:
City: *
State: *
Zip: *
Fax (if any):
Phone:
Cell Phone:
Email:

 

B. INTEGRITY AGREEMENT DOCUMENT

 

As a Charter Business Member and Video Channel Member of ELITE SPORT PSYCHOLOGY GROUP ™

I promise:

  1. To never hack into the website of the Success Factors Scales ™ - Athletics Edition/Success Factors Scales ™ - Corporate Edition to illegally steal technology or fraudulently access/change any aspect of the instrument.
  2. To never copy, reproduce, or change any literature that contains a trademarked name/logo on it. This would include the business card, stationery, promotional pamphlet, and Group clothing.
  3. To act honorably and responsibly as a professional sport psychology consultant when dealing with all clients.

I accept these terms and conditions to become a Charter Business Member or Video Channel Member of ELITE SPORT PSYCHOLOGY GROUP ™.

 

C. CHARTER BUSINESS MEMBERSHIP FEE

 

 @ $1,995.00 =  

 

D. VIDEO CHANNEL MEMBER FEE

 

1 Year Membership Fee @ $99.00 =   

 

E. ORDER/REORDER

 

1.  Success Factors Scales ™ - Athletics Edition Codes @ $10.00 each  
2. packages of 100 personalized business cards @ $65.00 each 
3. packages of 250 personalized business cards @ $95.00 each 
4. packages of 100 personalized letterhead stationary @ $75.00 each 
5. packages of 100 personalized Group envelopes @ $75.00 each 
6. packages of 100 promotional brochures @ $95.00 each 
7. packages of 250 promotional brochures @ $125.00 each 
8. Short-sleeve Performance Polo shirt(s) with Group logo @ $35.00 each

(Men color: Navy. Men size: Small, Medium, Large, XL, 2XL, 3XL, 4XL, 5XL, 6XL)
(Women color: Berry. Women size: Extra Small, Small, Medium, Large, XL, 2XL)
Indicate sizes and colors:
 
9. Long-sleeve Performance Polo shirt(s) with Group logo @ $45.00 each

(Men color: Light blue. Men size: Small, Medium, Large, XL, 2XL, 3XL, 4XL)
(Women color: Light blue. Women size: Small, Medium, Large, XL, 2XL, 3XL, 4XL)
Indicate sizes and colors:
 
Total: 

 

Card Type:
Card Number:   
Expiration:        

 

 If billing address is different than above