1. Surveys
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  5. Vemma Interest Survey
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First Name:
   
 
 
 
Last Name:
   
 
 
 
Phone Number:
   
 
 
 
Email Address:
   
 
 
 
Are you interested in the VEMMA Product Line for:
 
Health Benefits
 
Building a Part-Time/Full-Time Income
 
Both Health and Income
 
 
 
How many hours a week can you invest in your own business?
 
1-5
 
6-10
 
11-20
 
Full-Time
 
 
 
When is the best time to contact you?
 
Morning
 
Midday
 
Afternoon
 
Evening
 
 
 
If you were referred to this site by someone, please identify whom they were.
   
 
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