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Application Form for Copywriter Protégé Program Dear Carl, I am enclosing my payment for $4997 and understand that I will also have to pay for the phone calls I make to you as part of this program. I further understand that you may be making audio tape recordings of some or all of our sessions on the phone and I do hereby give you permission to do so and agree that you will have full ownership of these tapes to do with as you please. I also agree that any of the proprietary secrets, techniques, methods, ideas, procedures or materials that I receive will be kept in strict confidence and not revealed in any form to anyone else without your written permission. Date:_____________ Signature:___________________________________________   Name (print):_____________________________________________________ Address:________________________________________________________ City/State/ZIP:____________________________________________________ Phones (Day/Evening):______________________________________________ FAX:__________________ Email:____________________________________   For VISA/MasterCard/American Express orders only: Card #:______________________________________ Expiration Date:_______ Signature:___________________________________ Amount: $_____________ FAX/Mail or Email the above form with your payment. If you are Emailing the form, leave off your card #/exp date and place an X here:_____ . You will then be called for your card information. Carl Galletti PO Box 3934 Sedona, AZ 86340 Phone: (928) 649-2407; FAX: (928) 649-2409 Carl@AdSecrets.com

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