| First Name : |
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| Last Name : |
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| Birth Date : | |
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| Address : | |
| City & Zip : | |
Home Phone : | |
| Cell Phone : | |
Email : |
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Please answer the following |
Are
you taking any drugs which would cause sensitivity to sunlight? (Your
doctor would have provided this information when he prescribed the
drug.)
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Are you in any way allergic to sunlight?
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What is your natural hair color?
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Do you tan easily?
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Do you have oily or dry skin?
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Are you tanning for a special event?
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