Elite Legacy Education International Hall of Fame

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1 Elite Legacy Education International Hall of Fame Nominee Entry Form Basic Information: Name: Address: City: State: Zip: Phone: : 1. Have you attended the Training (two or three-day training held after the free preview)? Yes No When? Where? Who was your instructor? 2. Which elite level training did you choose to invest in (i.e. financial freedom, platinum, gold, etc )? 3. Do you have an Mentor? Yes No If yes, what is your Mentor s name? 4. Which elite training courses, if any, have you attended so far (Live and/or Online)? 1.

2 Real Estate Experience: 1. Why did you choose to get into real estate? 2. How many properties have you invested in since attending the Training (three-day training held after the free preview)? 3. What is the total value of those real estate holdings at this time (supporting documentation may be required)? 4. What was your approximate net worth when you attended the Workshop free event? 5. What is your approximate net worth today? 6. What portion of your net worth (amount answered in question 5) is directly related to real estate investing? 7. What was the approximate amount of positive cash flow you received monthly from any investment properties prior to attending the free Workshop? 8. What is the approximate amount of positive cash flow you receive monthly from your current investment properties (please do not include properties that are currently under contract in this total)? 9. What stands out in your mind as a major contributor to your success and why? 2.

3 10. Please describe your most memorable real estate transaction since getting involved with. 11. Please describe your most profitable real estate transaction since getting involved with. 12. What is the best part of being a real estate entrepreneur and being in control of your financial future? 13. Have you been able to move out of the Rat Race? a. If Yes, how long did it take to reach financial independence? b. If No, when do you foresee yourself reaching this goal? 14. At this stage of your investing career, what is your dream? 3.

4 wishes you the best of luck and greatly appreciates the time you took to fill out this questionnaire. Sharing your success can inspire others more than you may realize. Please be prepared to submit the following items if you are chosen as one of our inaugural Hall of Fame inductees. 1. Photos of yourself, spouse, partner and/or family members (at least four pictures)* 2. Photos of as many of your properties as possible (at least four)* 3. Photocopies of substantiating documentation that support your real estate transaction accomplishments (claims made in the above questionnaire). *These items will be used to create an inspirational video presentation to be shown at our Symposium events and other marketing related platforms. Items provided may not be returnable. Digital submissions can be sent via to Hardcopies should be mailed to: Attn: Keith Gensor 1612 E. Cape Coral Pkwy. Cape Coral, Florida Keep up the good work, and we look forward to seeing you on the Fast Track soon! Yours in success, 2015 LEA Brands Inc. All Rights Reserved. The Elite and Legacy Education Alliance word marks and logos are owned by LEABrands, Inc. and their use is under license. Elite Legacy Education, Inc. is a subsidiary corporation of Legacy Education Alliance, Inc. 15ELEUS

5 TESTIMONIAL CONSENT AND RELEASE I, the undersigned, of legal age, hereby irrevocably grant to, its subsidiaries, affiliates, agents, licensees, successors and assigns thereof (hereinafter referred to as Company ), claiming under or through same, the following rights to use the materials and/or items described herein in any fashion, form, or media, whether currently in existence or hereinafter devised: 1. The right to photograph, record, videotape, store, and use the undersigned s name, voice, appearance, likeness, signature and/or written testimony or statement along with any material furnished by me, in whole or in part, in any training, training materials and/or advertising materials produced, used or provided by Company, its subsidiaries, affiliates, agents, licensees, successors and assigns thereof, through means of mass, digital, and/or electronic media, including but not limited to printed, radio and television, promotional materials or events, and/or marketing plan, the Internet, and any other media and for all other types of advertising, publicity, promotion and other trade purposes for Company, its products and services; 2) The right to publish, text, exhibit, distribute and use the written or recorded testimonial or statement, or any parts thereof, my likeness and image, which shall appear as follows: first name and surname, general location of residence, and, where applicable, accompanied by photographs and/or recordings and/or signature, for commercial and/or non-commercial purposes, including but not limited to the advertising or solicitation of purchases, anywhere in the world where Company conducts business or intends to conduct business. I, the undersigned, hereby grant Company full ownership of and complete interest in any copyright I may have with regard to any written statement or other tangibly-fixed expression, which I have provided. I, the undersigned, hereby release and agree to indemnify and hold harmless Company, its subsidiaries, affiliates, officers, directors, agents, owners, employees, successors and assigns thereof, from any and all claims, actions, causes of action, damages, expenses, courts costs, attorney fees, liability damage or judgment suffered by the undersigned regarding the undersigned s participation in or testimonial furnished by the undersigned to Company. I, the undersigned, hereby acknowledge that I have not been paid or otherwise compensated for the rights granted above. I further certify that all material, whether verbal, written or exhibited by me is not scripted or coached and represents my individual opinions and beliefs, and are true and correct to the best of the my knowledge. I, the undersigned, hereby acknowledge that I have read this document and understand its contents. I further acknowledge that I have executed this document voluntarily, free from any coercion or duress. Signature Date Name: Address: _ City: State: Zip: Phone: Address: 5.

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