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Positive Impact Smoothies Connection Form
We would love to keep in touch with you! Please sign up to stay connected!
7
Questions
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1
Name
Mr./Mrs./Ms.
First Name
Last Name
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2
Phone
(10 digit number)
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3
E-mail
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4
Preferred communication method:
(Choose all that apply)
Email
Text message
Phone Call
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5
Would you like to receive occasional wellness tips, product updates, and special offers?
(We promise not to spam you)
YES
NO
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6
How did you hear about us?
Where did we meet...
Please Select
- Kalahari Wellness Event
- CPHS Bazaar
- Other
Please Select
Please Select
- Kalahari Wellness Event
- CPHS Bazaar
- Other
If other, please share where?
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7
Comments, Questions, or Suggestions
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