Spring Cleanse Registration Spring Cleanse Registration Name Email Cell Phone Address/City/State/Zip Emergency Contact (Name & Phone) Registering for: 2020 Ayurvedic Autumn Cleanse with Kelley Gardner What are the top 3 reasons you want to participate in the spring cleanse? Are you being treated by a medical professional for any medical conditions? If so, please explain. Do you have allergies or an intolerance to small amounts of dairy in the form of ghee (clarified butter)? Select one No Yes Have you had your gallbladder removed? Select one Yes No Referred By (List one person, please): Payment: Date of payment _____________________ Zelle – 704-663-9550 Paypal – PayPal.me/KelleyGardner007 Venmo – @Kelley-Gardner-7 Submit If you are human, leave this field blank.