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* 1. We will only use your First Name, City & Country for marketing purposes. If you would like to be kept anonymous, please enter ANONYMOUS as your name.
We REQUIRE your email address in order to provide you with a $5 gift card that you can use towards your next purchase with Healing Mama Co.

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* 2. If you would like us to tag you in our post(s) of your review please provide us with your appropriate handles. Otherwise, you can leave this section blank if you do not want to be tagged.

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