Workplace Wellness Chair Massage Request
Fill out the form below and Erica will be in contact with you about scheduling a chair massage day at your office.
Business Name
*
Business Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Your Name
*
First Name
Last Name
Your Role Within the Business
*
Your Phone Number
*
Please enter a valid phone number.
Your Email
*
example@example.com
How would you prefer to be contacted?
*
email
phone
About how many people does the business employ?
*
Would you be interested in making this a regular (monthly/bi-monthly) event?
*
Yes
No
Maybe
Please leave any other information here that would be helpful about your company or event.
exp. Type of business, questions, days/times, etc.
Submit
Should be Empty: