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904-487-9254 /  904- 510-9566

info@galacar.com

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Call: 904-487-9254Open: Tues - Sat Call: 904-487-9254

 

 

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904-487-9254 info@galacar.com

         

 

 

Sell GA LA CAR

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GA LA CAR Rep
Sell Fashions, plus

 

What's your beauty style? 

Mothers and Daughters this is the One Stop for You...

Diabetic DevahsChoose It and Lose It with me...the weight project that rewards

Copy/Paste onto Email and send:

Date:______________________   Referred by:_________________________________

NAME:    ___________________________________________         DATE OF BIRTH: ___________________________AGE:_______        __________________________              

ADDRESS: ______________________________________________________________________________________________________

TELEPHONE: ___________________________EMAIL ADDRESS: ________________________________CELL:__________________

MAILING  ADDRESS:____________________________________________________________________________________________________

IN CASE OF AN EMERGENCY, NOTIFY: _____________________________________  TELEPHONE NUMBER : ______________________

Commitment Fee:   YES: _______________  NO:___________________ (No: only entitles you to a gift certificate) 

Non-refundable Fee Received On:_________________________   Online: _______________  Store Location:______________________________    

Health Facility Name and Location _____________________________________________________   

Weight Loss Segment: 1)  January 12 - February 5, 2009   2)  February 9, 2009 - March 5, 2009   3) March 9, 2009 - April 3, 2009   4) April 6, 2009 – May 1, 2009  5) ALL                   Must participate in a minimum of 2 segments 

Weight Now: __________________  Weight Goal:__________________  Dress Size Now:_________________ Dress Size Goal: _________________

Health:  Diabetes              Cholesterol               High Blood Pressure               At "Risk"                    

Other: Please specify:

Limited to 20 Participants

Please consult your physician before beginning any weight loss program, project, or plan

ADDITIONAL INFORMATION

FUTURE GOALS: ________________________________________________________________________________

Suggestions: ______________________________________________________________________

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Contact me at: diabeticdevahs@galacar.com   

2640 Ceaery Blvd., Suite 11, Jacksonville, Fl 32211