Lifted Academy

First Name

Last Name

*Your email address serves as your username to access your training portal.

I was referred by:

Cell Phone

Billing Address

Address 2

City

Zip Code

MY ORDER

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PLEASE READ TO ENSURE YOU RECEIVE YOUR RECEIPT

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1) Enter your email address correctly above.

2) Add ted@liftedacademy.com and support@liftedacademy.com to your contacts.

3) Ensure the emails have not gone to spam or promotions.

PAYMENT OPTIONS

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Pay with Credit Card:

Name On Card

Card Number

CVC