Spring Cleanse Registration Spring Cleanse Registration Name Email Phone Address/City/State/Zip Emergency Contact (Name & Phone) Registering for: Ayurvedic Spring 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 Payment Zelle – use 704-663-9550 to find me (WellsFargo Zelle) Paypal – use link PayPal.me/KelleyGardner007 Check- payable to Kelley Gardner Yoga, Inc. Mail: 22007 Lady Glencirn Ct., Cornelius, NC 28031 Submit If you are human, leave this field blank.