Kangen Machine Pre Qualification Form & $1 Dollar Free TRIAL 

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1.Which Best Describes You?
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2.Who invited you to this WEBSITE? VERY IMPORTANT: if you don't have a name of who invited you, list any information you may have (email, text, phone #. social media) as we want to make sure each person gets the proper credit for your attendance (just as we will do the same for those you invite)
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3.What is your Full Name
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4.What is your email address?
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5.What is your phone number? (Social Media Handle also Works - IG/FB/Twitter)
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6.How Do We Contact You Best?