Party door prize Entry Form
*Welcome to the party fun! Please note, Pure Romance parties are for ladies only, 18 years & old. No men or minors.
Birthday
*
-
Month
-
Day
Year
Date - you will get something special from me 😉
Anniversary
-
Month
-
Day
Year
Date ... you will get something special from me 😉
Name
*
First Name
Last Name
Preferred Name/Facebook Name
First Name
Last Name
Shipping Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Billing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Phone Type
*
Cell
Home
Work
Business
Other
Select from drop down
Hostess Name
*
Are you interested in earning free & discounted products?
*
Yes
No
Are you interested in hosting your own party?
*
Yes, a catalog party
Yes, a Facebook party
Yes, a home party
No, but maybe in the future
Other
Are you interested in joining the newsletter mailing list?
*
Yes
No
Are you interested in info on becoming a consultant?
*
Yes
No
Extra Entries for:
*
Joining my vip group
For each friend that joins my vip group
For your partner joining my vip group
Scheduling your own party
Rules:
What Happens in the party stays in the party
You can not yuck someone else’s yum
And I ask that you tell everyone you know about Pure Romance
Submit
Should be Empty: