Private Home Application

for RAYD8® REGEN Technology

Private Home Application Form

First name

Last name

Address

City

State/Province

ZIP/Postal Code

Country

Phone

If yes, please provide name of referral

By clicking agree below, you are revealing information through this form that is truthful pertaining to your private home application. You also agree that confirmation may take up to 1-4 business days and that when confirmed, a one-time, non-refundable $2,000 USD License fee will be due to complete your License application and enable your online membership with RAYD8REGEN.com where you will have access to tutorials and other content to help you in your setup & installation of the RAYD8 REGEN technology and equipment. If you accept the terms and conditions, please check the box below.

I accept and agree to the terms & conditions stated above.

Thank you for submitting your appllication. Review and confirmation of your application may take up to 1-4 business days. Once reviewed, we will contact you by email confirming your application submission. Thank you!