The document contains a form for collecting contact information from individuals interested in hosting Pure Romance parties or becoming Pure Romance consultants. It requests the person's name, address, email, phone number and asks them to check boxes to indicate if they are interested in hosting a party, learning more about becoming a consultant, or being added to a mailing list. The form is repeated three times to collect information from multiple people.

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.