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Seasonal Health & Wealth Empowerment Tour Intake Form
Your HEALTH is your WEALTH!
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* Indicates required question
Email
*
Your email
Are you a Powerful Pioneers' Member?
*
Yes
No
First Name & Last Name
*
Your answer
Phone Number
(***) ***-****
*
Your answer
When is your Earthstrong (
Birthday
)?
*
MM
/
DD
/
YYYY
Which tour date are you joining?
*
March 16 - 20: Houston, TX
June 22 - 26: Orlando, FL
September 21 - 24: New York / New Jersey
December 15 - 18: Virginia / DMV
Multiple Dates (You will be contacted)
None
Which level are you joining?
*
Attendee
Business Owner
Sponsor
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