Ron LeGrand's Platinum Inner Circle Application Ron LeGrand' Platinum Inner Circle Application Name * Do you have children? No Yes Number of Children Ages of Children Address * Address Address Address City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Cell Phone * Email Address * Do you currently have a website? No Yes Website Address Are you an Info-Marketer? No Yes Full Time/Part Time Full Time Part Time How Long? What Industry? What Do You Sell? Business Annual Income * Do you consider yourself a leader? No Yes Can you take input without being argumentative? No Yes Next If you are human, leave this field blank.