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Tanning Salon Membership

..:: Your Information

Name*:
Sex: M F
Date of birth 19 *
E-mail*:
Phone number*:
Cell phone:

..:: Address

Street Line 1
Street Line 2
City:
Province:
Postal Code:

..:: Emergency contact

Name*:
Phone number*:

..:: Other Information

Do you take these medications (If yes to any, its recommended not to tan)

Tetracyclines
Sulfonamides
Phenothiazines
Thiazides
Psoralens
Chlorpromazine

Do you burn easily? Y N
Do you have any reactions to sun light? Y N
How did you learn about our tanning service?
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