<h1 style="text-align: center;">Thank you for your order!</h1>
<h6 style="text-align: center;">Check your email for your confirmation and Access Code. You should receive it within a few minutes. If you don’t, please check your spam folder.</h6>
<div class="icon_box" style="width: 50%; margin: 30px auto;"><form class="infusion-form" accept-charset="UTF-8" action="https://beliefcloset.infusionsoft.com/app/form/process/6430086e2fd4ab1d24af175de21dedd2" method="POST">
<h6><input name="inf_form_xid" type="hidden" value="6430086e2fd4ab1d24af175de21dedd2" /><input name="inf_form_name" type="hidden" value="clearyourbeliefs.com/registration" /><input name="infusionsoft_version" type="hidden" value="1.31.0.28" /></h6>
<div class="infusion-field">

<label for="inf_field_FirstName">First Name *</label>

<input id="inf_field_FirstName" class="infusion-field-input-container" name="inf_field_FirstName" type="text" />

</div>
<div class="infusion-field">

<label for="inf_field_LastName">Last Name *</label>

<input id="inf_field_LastName" class="infusion-field-input-container" name="inf_field_LastName" type="text" />

</div>
<div class="infusion-field">

<label for="inf_field_City">City *</label>

<input id="inf_field_City" class="infusion-field-input-container" name="inf_field_City" type="text" />

</div>
<div class="infusion-field">

<label for="inf_field_Email">Email *</label>

<input id="inf_field_Email" class="infusion-field-input-container" name="inf_field_Email" type="text" />

</div>
<div class="infusion-field">

<label for="inf_custom_GoodDaysforCoaching0">Good Days for Coaching *</label>

<select id="inf_custom_GoodDaysforCoaching0" multiple="multiple" name="inf_custom_GoodDaysforCoaching0" size="7"><option value="Monday">Monday</option><option value="Tuesday">Tuesday</option><option value="Wednesday">Wednesday</option><option value="Thursday">Thursday</option><option value="Friday">Friday</option><option value="Saturday">Saturday</option><option value="Sunday">Sunday</option></select>

</div>
<div class="infusion-field">

<label for="inf_custom_GoodTimesforCoaching">Good Times for Coaching *</label>

<select id="inf_custom_GoodTimesforCoaching" multiple="multiple" name="inf_custom_GoodTimesforCoaching" size="4"><option value="Morning (8 am to 11 am)">Morning (8 am to 11 am)</option><option value="Mid-day (11 am to 2 pm)">Mid-day (11 am to 2 pm)</option><option value="Afternoon (2 pm to 6 pm)">Afternoon (2 pm to 6 pm)</option><option value="Evening (6 pm to 10 pm)">Evening (6 pm to 10 pm)</option></select>

</div>
<div class="infusion-field">

<label for="inf_custom_TimeZone">Time Zone *</label>

<input id="inf_custom_TimeZone" class="infusion-field-input-container" name="inf_custom_TimeZone" type="text" />

</div>
<div class="infusion-field">

<label for="inf_field_Password">Please choose your own passcode. *</label>

<input id="inf_field_Password" class="infusion-field-input-container" name="inf_field_Password" type="password" />

</div>
<div class="infusion-submit">

<input type="submit" value="Register" />

</div>
</form></div>