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New Customer Registration Form
Get new customers easily using this Customer Registration Form.
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1
Full Name
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First Name
Last Name
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2
E-mail
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3
Where do you live?
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Right now my program ships to Canada, the US and UK. If you live in another country, than those listed, I'll gladly keep your contact info for when we do launch in your country!
Canada
USA
UK
Other
Canada
USA
UK
Other
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4
What's your Instagram handle?
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5
Which option appeals to you most right now?
*
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I'd love to create a life of freedom through coaching and working hard for it!
I'd love to earn some spending money!
I want to get my own products paid for!
I want to get healthy and earn 25% of all products!
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6
Are you currently a coach or working with one?
*
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YES
NO
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7
Please tell me anything else that you'd like me to know about you! And thank you for completing this form, I'll be in touch soon!
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