Wellness Business Application

Application for Business Membership

Mission Statement - Build relationship with other like-minded Professionals to better the community by connecting individuals with wellness. We seek to create a community of wellness minded professionals collaborating together to create awareness and education to

Please complete the form below. Upon it's approval, you will be notified to complete your Membership payment of $150.00.

* Indicates required field

Name *

First

Last

Industry *

Business Name *

Professional Title *

Business Address *

Line 1

Line 2

City

State

Zip Code

Country

Experience in Professional Title *

Years in Professional Title *

Email *

Phone Number *

Are you willing and able to attend the bi-monthly Business Meetings and the alternating Community Wellness Meetings, in their entirety; abide by the policies, guidelines, and code of ethics? *

Yes No

Is the Professional Title in which you are applying your Primary Occupation? If not, what is your Primary Occupation? *

Are you commited to growing the Community by inviting guests to attend via social media and word of mouth? *

Yes No

Do you belong to another/other networking group(s)? If so, please list the name(s) below. *

How do you feel that you can best support the Community? *

Has your Professional Title ever been Revoked or Suspended? *

Yes No

Have you ever been convicted of a felony? *

Yes No

Please Upload your Headshot to be Listed on the Website upon Approval of Application *

Max file size: 20MB

I will provide the quality of services at the prices that I have quoted.
I will be truthful and build goodwill with the members and their referrals.
I will take responsibility doing my due diligence on their referrals I receive.
I will live up to the ethical standards of my profession.
I will display a positive and supportive attitude.

Virtual Signature *

First

Last

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