MEMBERSHIP FORM (For South Australian Residents Only) For residents outside South Australia membership is automatic when a purchase is made. Please fill out our membership form to join our DISCOUNT CLUB (all information will remain strictly confidential and never be given out to anyone else). NAME Mr Mrs Ms Miss Initials Surname POSTAL ADDRESS                                                                     STREET: TOWN: POST CODE: COUNTRY: PHONE NO: E-MAIL: DATE OF BIRTH: PLEASE TICK AT LEAST ONE OF THE BELOW... INTERESTS: VITAMINS SKIN/HAIR CARE BODY BUILDING HERBS DO YOU HAVE ANY PARTICULAR AILMENT SUCH AS ARTHRITIS OR INSOMNIA? NAME AILMENT: COMMENTS:

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