AFFILIATE Application/CODE - 2023 Liberated Minds Expo Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Thank you for your interest in becoming a Liberated Minds Expo affiliate. Once you complete this application, submit it, and one of our representatives will reach out to you soon. Please be reminded that this event is SPECIFICALLY DESIGNED FOR BLACK FAMILIES ONLY!!!

Email *

Full Name *

Phone Number

Affiliate CODE? *

Please choose a unique discount code (7 letters/numbers or less) that you would like to use as your affiliate code. It can be whatever word you choose such as your name, a word associated with your business, a word of empowerment, etc.

City & State of Residence *

Organization/Company Name (If Applicable) *

Have you been an affiliate for the Liberated Minds Expo before? *

Yes

What are some of your primary reasons for wanting to be an affiliate? *

Have you participated in the Liberated Minds Expo before? *

If not, are you familiar with the mission and works of The Liberated Minds Black Homeschool and Education Institute?

Yes

Payment Method Option #1 - CASH APP (Please provide your $CashTag below)

Payment Method Option #2 - PAYPAL (Please provide your preferred PayPal email address & account name below)

Payment Method Option #3 - ZELLE (Please provide your preferred Zelle payment info below)

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms