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First Name : *
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Name of your Standard Process representative : *
Professional Training (check all that apply) : *
Name the Standard Process Whole Food Nutrition Seminars you have attended in the past : *
Have you attended Gerald Roliz’s "Nutritional Therapy in a Pharmaceutical World" seminar before? *
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Are you interested in a bulk order purchase for The Pharmaceutical Myth at wholesale to distribute to your clients/patients? *
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Number of books interested in purchasing:
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