Name:
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Email Address:
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Contact Number
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When is your birthday?
(Our birthday boy/girl will receive exclusive promotions from us)
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How did you hear about us
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Facebook
Email
Printed Advertisement
Friend
Promotional Event
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Please state his/her referral code (if you heard about us from a friend)
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Would you like to receive updates via email of any ongoing promotions for our product?
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Yes
No
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We will send you an email and notify your membership code. Thank you :)
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