1. Name : __________________________________________________________ Name : __________________________________________________________ Name : __________________________________________________________
Address : ______________________________________________________ Address : ______________________________________________________ Address : ______________________________________________________
______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________
Email : ___________________________________________________________ Email : ___________________________________________________________ Email : ___________________________________________________________
( )
Phone : _________________________________________________________ ( )
Phone : _________________________________________________________ ( )
Phone : _________________________________________________________
Yes, I would like to host a Yes, I would like to host a Yes, I would like to host a
Pure Romance Party. Pure Romance Party. Pure Romance Party.
Yes, I would like to learn more about Yes, I would like to learn more about Yes, I would like to learn more about
becoming a Pure Romance Consultant. becoming a Pure Romance Consultant. becoming a Pure Romance Consultant.
Yes, I would like to be included on your Yes, I would like to be included on your Yes, I would like to be included on your
mailing list. mailing list. mailing list.
Name : __________________________________________________________ Name : __________________________________________________________ Name : __________________________________________________________
Address : ______________________________________________________ Address : ______________________________________________________ Address : ______________________________________________________
______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________
Email : ___________________________________________________________ Email : ___________________________________________________________ Email : ___________________________________________________________
( )
Phone : _________________________________________________________ ( )
Phone : _________________________________________________________ ( )
Phone : _________________________________________________________
Yes, I would like to host a Yes, I would like to host a Yes, I would like to host a
Pure Romance Party. Pure Romance Party. Pure Romance Party.
Yes, I would like to learn more about Yes, I would like to learn more about Yes, I would like to learn more about
becoming a Pure Romance Consultant. becoming a Pure Romance Consultant. becoming a Pure Romance Consultant.
Yes, I would like to be included on your Yes, I would like to be included on your Yes, I would like to be included on your
mailing list. mailing list. mailing list.