Event Registration Form
Full Name
*
First Name
Last Name
Phone Number
*
E-mail
*
example@example.com
How did you hear about this Event?
*
Please Select
Instagram
Facebook
Website
Referral
Previous Event
From Host
Other
Referral Name (If Applicable)
*
What are you current Wellness Goals?
Stress Relief
Sleep Support
Improved Digestion
Increased Energy Levels
Balanced Hormones
Clearer Skin
Weight Loss/Management
Enhanced Immune Health
Reduce Medications - thyroid, BP, blood sugar, etc.
Other
What are you most interested in learning more about?
Essential Oils
Treatments - Raindrop Therapy + Detox Foot Baths
Natural Home Cleaning
Ningxia Red (Superfood / Antioxidants)
Supplementation
Other
Would you be interested in hosting a Wellness Party/Experience?
Yes
No
I'd need more info
I hereby agree and consent as follows. I consent and authorize Drops of Health, to use my likeness in any photograph, video or other digital media ("Photos") taken or to be taken on during this Wellness Event, in any and all of its publications, including print or web-based publications. I irrevocably authorize Drops of Health to copy, edit, enhance, crop, or otherwise alter any Photo for use in their publications. I also waive any rights for approval or inspection of any Photos. I understand and agree that all Photos are the property of and will not be returned to me. I acknowledge that I am not entitled to any compensation or royalties with respect to the use of the Photos. I agree to release and forever discharge Drops of Health and its affiliates, successors and assigns, officers, employees, representatives, partners, agents and anyone claiming through them, in their individual and/or corporate capacities from any and all claims, liabilities, obligations, promises, agreements, disputes, demands, damages, causes of action of any nature or kind, known or unknown, which I, and anyone claiming on behalf of me, may have or claim to have against Drops of Health in connection with this Release. I have carefully read and fully understand all the provisions of this Photo Release Form and am freely, knowingly and voluntarily signing.
*
I agree
Submit
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