Ready for your Golden Glow
First we would like to get to know a little about you…
Email address *
NAME *
Your answer
Select your preferred Golden Glow...
Add Golden Prep and maximize the wear of your Glow!
When is your B-Day? *
MM
/
DD
/
YYYY
Add your email for a Birthday Glow gift!
Your answer
How did you hear about V.Helene?
Your answer
Have you received a spray tan or applied a sunless tanner before?
Any known allergies? *
Your answer
Any allergies related to Dihydroxyacetone (DHA)? *
Do you have any respiratory illnesses? *
Are you or could you be pregnant? *
Are you under a doctor’s care presently?
If yes, please list the medical condition:
Your answer
Next
Never submit passwords through Google Forms.
This form was created inside of V. Helene. Report Abuse - Terms of Service