LXCouncil Member Application / Agreement Form

Please complete the following:

Section 1: Registrant Information

Section 2: Complete Payment Information

Section 3: Sign the Release, Nondisclosure, Acknowledgment and Waiver Agreement

1. Client Information

Name

First Name

Last Name

Title

Company Name

Phone

Country

(###)

###

####

Cell

(###)

###

####

Primary Email

Birthday

YYYY

Souse, Partner, and/or Significant Other

2. Company Details

Company Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Industry

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Billing Contact

First Name

Last Name

Billing Phone #

(###)

###

####

Billng Email

Billing Address (if different from above)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Revenue

Number of Employees

3. Dues and Details

Registrants of the CEPA Accelerator Program may choose from two different payment options: Option 1: Billed $1,000/mo for 12 months (Total fee: $12,000) Option 2: One-time upfront fee of $11,000

Please select your preferred payment option

Billed Monthly

One-Time Payment

4. Terms of Agreement

Please review the following Terms of Agreement. Click the accept button below to indicate acceptance of these program terms. Acceptance of these terms is required for registration. Our Commitment to You Monthly 3-hour peer-to-peer group meeting Professional moderators that lead your meetings with a well-planned agenda Constant innovation within the council meetings for continuous learning and growth Be open to feedback and 100%-member satisfaction No conflict of interest present in your council Creating an environment of achievement and results _____ Registrant Commitment and Expectations Maintain confidentiality by agreeing to our non-disclosure agreement Commit to prioritizing your monthly meeting on your calendar Notify your moderator in advance of the meeting if you are running late or will be absent Be on time for your meetings Contribute to each meeting by being fully present for others as well as yourself Exhibit mutual trust and respect to all Communicate areas of improvement openly and directly to your moderator Read the “before your first meeting” section in your CEPA Accelerator Program Onboarding Document and be prepared to answer the questions at your first meeting with your moderator Attend the onboarding call ____ Cancellation Policy Registrants may request a refund up until 30 days after their first peer group session. If a refund is requested in this timeframe, the registrant will be awarded a full refund minus a $1,000 program fulfillment fee. Once the 30-day timeframe after the first peer group session has passed, the program is non-refundable. If due to an unforeseen circumstance, the registrant is no longer able to attend sessions for the group they were originally assigned to, the registrant may request to be transferred to a different group at a later date. All transfer requests are subject to the approval of the Exit Planning Institute. ____ RELEASE, NONDISCLOSURE, ACKNOWLEDGMENT, AND WAIVER AGREEMENT In registering for the CEPA Accelerator Program, both I and the Exit Planning Institute hereby agree to maintain in confidence all information and data ("Information") received from Exit Planning Institute, Participants, moderators, or guests who attend any CEPA Accelerator Program meeting. Both I and Exit Planning Institute agree and acknowledge that all Information received is on a strictly confidential basis and will not be divulged to any other person or entity for any indefinite period of time. Both I and Exit Planning Institute also agree not to use any Information supplied in any way that is or would be detrimental to any Participants, nor to use the Information to compete or aid others to compete, directly or indirectly with any Participants. I desire to participate in the CEPA Accelerator Program as a contributor to the free, open, and confidential exchange of ideas and information in conjunction with Exit Planning Institute. I understand and acknowledge that certain Participants may be licensed professionals in a variety of disciplines and that Participants are merely providing suggestions based on their personal and business experiences. I acknowledge and agree that none of the Participants and Exit Planning Institute are acting in a professional capacity in their role as a Participant; that the comments and suggestions of any Participants and Exit Planning Institute do not constitute advice given in a professional capacity; and such advice should not be relied upon by myself. None of the Participants or Exit Planning Institute will in any way be liable to me for any damages relating to or arising out of any comments or suggestions made, or the implementation of those comments or suggestions. I do hereby release, discharge, and agree to hold harmless Participants and Exit Planning Institute from all liability, claims, demands, losses, or damages on account of or in any way related to my participation in the CEPA Accelerator Program and any of its activities. I agree to comply with any rules and regulations relating to the CEPA Accelerator Program as may be enacted from time to time by Exit Planning Institute or a CEPA Accelerator Program moderator. If any term or provision of this Agreement is to any extent invalid or unenforceable, the remainder of this Agreement shall be unaffected thereby and will remain in full force and effect. By clicking the box below, I indicate acceptance of all the terms outlined in this Registration Form & Agreement for participation in the CEPA Accelerator Program, including the Commitment and Expectations outlined on this page. This also acknowledges that I have read and understood the full Non-Disclosure agreement. I accept that failure to comply with any term or provision of this Agreement may result in my immediate removal from the program and that no refund will be issued if a violation has occurred.

I accept the Terms of Agreement as stated above.