Sprout Request Form
HydraFacial Experience Center Locations
*
Choose City
Chicago
Dallas
Long Beach
Orlando
2020 Available Dates for Chicago
*
3/25/20
9/9/20
2020 Available Dates for Dallas
*
5/20/20
11/4/20
2020 Available Dates for Long Beach
*
2/26/20
8/19/20
2020 Available Dates for Orlando
*
4/24/20
9/18/20
Account Information
Account name
*
First name
*
Last name
*
Title
*
Email
*
Cell phone number
*
City
*
State
*
Please select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Gender
*
Please select
Male
Female
Clothing size
*
Please select
S
M
L
XL
XXL
Experience with HydraFacial (length of time)
*
Do you know your HydraFacial representative?
*
Yes
No
Your HydraFacial representative
*
When is the best time to contact you
*
:
Hours
Minutes
AM
PM
AM/PM
Dietary restrictions or other considerations
*
Additional comments
Terms and Conditions
Attendees must complete all sessions of Sprout be eligible to receive certification from HydraFacial. Travel accommodations, including ground transportation to attend Sprout and other events are the responsibility of the Attendee. HydraFacial shall not reimburse for travel or expenses associated with the Attendee's participation at any sponsored HydraFacial event; unless otherwise agreed to in writing. Any HydraFacial scheduled after-hour activities are considered social and voluntary. Non-registered guests are not eligible to participate in the course or related activities. Attendees of Sprout shall indemnify and hold HydraFacial harmless of and from all liability for damages related to personal injuries or property damage that may result from or be in any way related to any HydraFacial sponsored event. HydraFacial reserves the right to charge a $400 cancellation fee for any Attendee who cancels within seven (4) days before the start of the Sprout session if HydraFacial is unable to fill his or her position.
Terms & Conditions
*
By clicking SUBMIT, I agree to the terms and conditions listed above.
Comments
This field is for validation purposes and should be left unchanged.