Healthy Shoppers Seminar Tasting Form

Healthy Shoppers Seminar Tasting Form

BODY BY JEANAI LLC Healthy Shoppers Seminar and Tasting Registration Form

This form is for you to complete and confirm your registration for the upcoming Healthy Shoppers Seminar and Tasting Event featuring one of Chicago's finest, Chef and Nutritional Expert

____________________________ on ___________________________

The menu will be posted 2 weeks prior to the event on the Healthy Shopper Seminar & Tasting Page.

Space is limited so register soon.

Personal Information

First Name

Self Assessment and Additional Information

How did you hear about us?

please specify website, publication or name of friend

This is my first Body By Jeanai Healthy Shoppers Seminar and Tasting

If you answered "no" to the above question, when was the last Healthy Shoppers Seminar and Tasting you attended?

I have embarked on a healthier lifestyle and would like to incorporate healthy meals with taste

I have had the Lap Band surgery and need to combine my eating regimen with healthy meals with taste for my family

I have had the Gastro Bypass surgery and need to combine my eating regimen with healthy meals with taste for my family

My main goal from attending the Healthy Shoppers Seminar and Tasting is to:

Please list any food allergies or intolerances that you have:

I would like to register for the Healthy Shoppers Seminar and Tasting event featuring ____________________, Chef and Nutritional Expert on _____________________. However, I understand and acknowledge that only my payment via PayPal will secure my seat.

I understand that once registration is completed and confimed with my payment that to cancel my attendance, Body By Jeanai has to be notified 72 hours before the event. If this condition is met, Body By Jeanai will issue me a credit towards the next Healthy Shoppers Seminar and Tasting. My credit is non transferable and I understand there are no cash refunds.

Agreement and Signature

Electronic Signature

Today's Date

Last Name

Address

City

State / Zip

Phone

Profession