Scholar Enrollment Form

Scholar Enrollment

Please enter your personal information below:

* Required fields must be completed

Enroller ID:* Enroller Name: Sarah Doherty

I confirm that the Enroller ID and Enroller Name above are correct.

Personal Information

Full Legal Name that shows on Social Security Card or EIN Form

First Name:*

Last Name:*

Company: (Only Enter if you are using a Company Tax-ID #)

Phone Number:* Example - 9596768799

Birth Date:*Example: mm/dd/yyyy - 05/15/1970

https://EpicTrading.com/

Username:* Your User Name can be between 1 and 20 characters long. Try to use a name that represents you and/or your company name. Please do not use invalid characters like spaces or !@#$%^&*()?.,<>'";:\/{}[].
Enter the unique "user name" in the box above that you want for your Website.
These will be your personal website to use and share. Please write down your website. Example - your "EpicTrading" website:
If you type "bob" in the box above, your Personal "EpicTrading" Corporate web address will be: https://EpicTrading.com/bob
All website address names are subject to approval by EpicTrading

Email Address:*

Please Verify Your Email Address:*

Address

Resident Country:*

Resident Address:*

Resident Suite/Apt:

Resident City:*

State or Province: Other:

Resident Zip:

The password you enter below will be used when accessing your backoffice. Please enter your password below twice to make sure it is entered correctly into our system. You must enter 1 upper case letter, 1 lower case letter and 1 number. No special characters are allowed.

Password:* (minimum of 7 characters)

Confirm Password:*

Select your Package:

Scholar Monthly Membership (35% Discount)
Your next payment will be due on 3/24/2022 - $1,052.92

By checking this box, I agree that I am 18 years of age or older.

By checking this box, I agree to the Terms of Use

By checking this box, I agree to the Policies & Procedures

By checking this box, I agree to the Refund Policy

Do Not Sell My Personal Information

Please Type Your Full Name Below:*