Professional Membership Form

Once you submit this form, you will be returned to the How to Join page where you can pay your annual membership fee using PayPal. Your membership is not effective until we have received BOTH this form and your payment. Send us an email if you have any questions.
 


The following information will be posted on www.hwpn.org.
 

Your Name

 

Business Name

 

Business Address

 

Business Phone

 

Fax Number

 

Cell Phone

 

Your Email - please type carefully

 

Your Web Site

 

Professional Certifications/Degrees (current only)

 

Professional Licenses/Numbers (if required in your listing)

 

Brief Descriptions of your Services (this may be edited if it is too long.)

 

Please look at our Members pages and pick two sub-categories under which you would like to be listed.  DO NOT provide a general category heading such as "Psychological Wellness" - please provide specific sub-categories only.

Category 1

 

Category 2

 

The following information will NOT be listed on our web site.

Alternate phone numbers

 

Alternate mailing address

 

DISCLAIMER AND AGREEMENT:  HWPN is a non-profit organization that does not sell or endorse any services or products.  It is a community business networking organization whose exclusive purpose is to bring together health and wellness professionals to  share ideas, learn from each other, and work for the betterment of the community.  HWPN and its Directors do not recommend or assume any responsibility for the services or products offered by its members.  Anyone who obtains any services or products from any of the businesses or individuals listed on our website or in our membership directory does so at his or her sole and complete risk and assumes sole and complete responsibility for any damages or liability that may results form such services or products.

Please check the box below to indicate your acceptance of this disclaimer.

 
 
We look forward to seeing you at a future HWPN event. For further information, please contact info@hwpn.org.
© 2007 Health & Wellness Professional Network.  Website by TesslerDesigns.