10 Day Hawaiian Sea Water Cleanse

Name_______________________________________
Address______________________________________
Phone_______________________________________
Email___________________________________________
List the kinds of cleanses you have done in the past______________________
____________________________________________________________
What is your objective for this cleanse?_______________________________
_____________________________________________________________
Please list any Heath Opportunities you have and current medications:____________
________________________________________________________________
Dormitory
$1500.00
Private Room
$2000.00
We also recommend Kohala Country Adventures Guesthouse for those needing who want a B&B setting. http://kcadventures.com/. You will pay the dormitory rate for the program and pay KCAdventures B& B their fee for 10 days.
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