If you are attending the IGNITE event as a guest, please fill out the form below. (All fields are required. )

If you have any issues, please email admin@jeffalexanderignite.com.  Thank you!

Guest registration

    First and last name of person you are registering with

    Your first name

    Your last name

    Email

    Phone

    Address

    City

    State

    Zip code

    Birth date (month/day/year)

    Age

    How did you hear about this program? (Please be specific)

    Emergency contact name

    Emergency contact relationship

    Emergency contact phone

    Health conditions - Please list and describe any physical conditions, injuries or concerns we should be aware of

    What value do you intend to get from this program?

    I HAVE CAREFULLY READ THE WAIVER (below) AND RELEASE OF LIABILITY AND FULLY UNDERSTAND ITS CONTENTS.
    YesNo

    Cancellation, Waiver, Release of Liability

    Refunds and transfers

    Your full tuition is refundable up until two weeks before the program.
    Within 7 days of the program, 50% of the tuition is refundable.
    If you cannot attend the program at the scheduled date, your tuition is transferable to another scheduled date of the same program.
    Guest materials fee is not refundable.

    Age Requirement:

    18 yrs or older

    Waiver Agreement:

    I voluntarily accept full responsibility for all risks arriving to, during and leaving the premises of the Ignite program. I agree to release, hold harmless and indemnify JeffAlexanderIgniteLLC, and any of its employees, staff members, volunteers, agents, contractors, subsidiaries, officers or owners from all actions, claims or demands for any loss, injury or damage which arises out of participation in this program.

    Recording of Audio/Video:

    I understand that JeffAlexanderIgniteLLC may record audio or video during sessions of the programs. I hereby give permission for myself to be audiotaped and/or videotaped and/or photographed during any IGNITE classes. I also give permission that such audio or videotape(s) and/or photograph(s) may be used by JeffAlexanderLLC for promotional, educational, training or commercial purposes.