ZeroG

SIGN-UP FORM for Private “Friends & Family Zero-G Flight”
with Peter Diamandis

PROGRAM COST: $4,950 + 5% tax: This is the standard cost for The ZERO-G Experience®: Weightless flight. The Program includes 15 parabolic maneuvers creating 20-30 seconds of weightlessness each, plus ZERO-G merchandise, pre and post flight catering, professional photos of ZERO-G Experience®, video of weightless experience and certificate of weightless completion.

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* 1. First Name:

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* 2. Last Name:

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* 3. Email:

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* 4. Mobile Phone Number:

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* 5. How many Zero-G seats are you interested in purchasing (limit 4):

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* 6. Peter will be hosting two Friends & Family flights (both in the LA area) the first on August 13th and the second on Oct 2nd 2016. Please indicate which one you have interest in participating in:

August 13th

October 2nd

I’m open to either

Neither date works, but let me know if there’s a future flight on a different date

PLEASE NOTE Seats are extremely limited. Completion of this form does not guarantee a seat until credit card info is taken. These flights are on a first come, first serve basis.

Thanks for completing this “inquiring form.” A member of our team will follow up with you shortly via email with instructions on how to sign up!