South Sound Healers Network

1. Please fill in the information to the best of your ability and click "submit" when you're finished.
2. If you would like to use your name as opposed to a business name, feel free to do so below
3. Your Name or Name of Business(required)
4. Contact Person
5. Would you like your contact person to be listed in the directory?
6. Yes No
7. Email(valid email required)
8. Website
9. Business Address(required)
10. Would you like your address listed in the directory?
11. Yes No
12. Primary Business Phone(required)
13. Would you like your phone number listed in the directory?
14. Yes No
15. Other Phone (just for our records)
16. Business Fax

17. Membership Information

18. Please enter at least one, but up to three categories you'd like to be listed under.
    
    *In the interest of streamlining the website, please choose from the categories already listed on the website. If you cannot find a category that fits, please enter a suggestion, and we will let you know if it's approved or not.
    
    **To select multiple categories hold the "ctrl" button while clicking the desired categories.
19. Categories Acupuncture / Acupressure Artists Bio Feedback Birth Services Breathwork Business Services Ceremonial Services Chiropractic Cleaning Services Coaching Computer Support Counseling Colon Hydrotherapy Craniosacral Therapy Dentistry Divorce Services Education / Workshops Energy Work / Spiritual Healing Environmental Health Family Constellation Work Flower Essences Homeopathy Hypnotherapy Intuitive Readings Massage Medical Billing Midwifery Naturopathic Medicine Nutrition Physical Therapy Restorative Touch Shamanic Practitioner Travel Web Design Yard / Landscape Services Yoga *Other (required)
20. If you could not find a Category that fits your business and clicked "other" in the above field, please input suggested Category below. However to keep things streamlined please only use this option if no other category truly fits.
21. Suggested Category
22. Please enter your Category description(s) below.
    
    Please limit your descripton to 600 characters (with spaces). Going over 600 characters will delay your entry going up.
23. Description of Category #1(required)
24. Description of Category #2
25. Description of Category #3
26. If there is any of your business information (ie: address, phone number) you would not like included in the online directory please let us know here
27. In your online directory entry we ask that you give us a photo of you or an image of your logo. The end image will be 100x100 square. If you don't know what that means, don't worry, we can edit it easily.
28. Upload your photo or logo
29. How did you learn about this organization?
30. Why are you interested in joining SSHN?
31. Membership in South Sound Healers Network is open to all business persons who are committed to living the principles and values set forth in our mission: SSHN is a professional circle of holistic healers in the South Puget Sound region. We promote health and wellness in individuals and communities through education about natural healthcare and local resources. Acting as change agents, we envision preventive medicine as mainstream and encourage living in balance with nature. Our membership includes the diversity of many healing arts professionals. We provide support, networking and referrals for practitioners healing and strengthening our South Sound community.
    
    All applications for membership will be reviewed and SSHN reserves the right to refuse any application for any reason.

32. RESPONSIBILITY OF MEMBERS

    * Willing to participate in creating a holistic community presence in this region.
    
    * Willing to contribute ideas, serve on committees and participate in events and activities whenever possible.
    
    * Commitment to the values, mission and purpose of SSHN.
    
    * Payment of yearly membership dues.

33. Membership begins the month you join and goes until the next Membership Renewal Period. Membership Renewals are on April 1st, 2013.

    
    
34. I have read and agree to the responsibilities of membership in South Sound Healers Network:
35. If you agree, please type your name(required)
36. Also, please verify your email(valid email required)
37. You can mail your check payable to SSHN at:
    South Sound Healers Network
    PMB# 326
    15127 Main Street E., Ste. 104
    Sumner, WA 98390
38. If you have any questions, please email us.
39. Thank you for your interest in joining the South Sound Healers Network!
40. Tell a Friend about the South Sound Healers Network! (not required)
41. Your Name
42. Your Email(valid email required)
43. Friend's Name
44. Friend's Email(valid email required)
45. If you are finished with your application please click the "submit" button below

 

cforms contact form by delicious:days

If you would like to purchase your membership by paypal or credit card as opposed to check please click the link below *after* finishing the application and clicking "submit":