Patronship Registration FHCi

Free and Healthy Children international Patronship Registration

By completing this registration with FHCi I affirm: I am voluntarily registering as a Patron of FHCi on behalf of myself, my spouse or partner and/or my dependents without any pressure or promise of cure of disease or disease prevention. I affirm that I do not represent any State or Federal agency whose purpose is to regulate and approve products. I affirm that I do not belong to any media outlet and I will not misrepresent any information regarding homeopathy or homeoprophylaxis. I affirm that I will not carry out any mission of entrapment or investigation.
Signature*

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Name*

First NameLast Name
Email*
example@example.com
Phone (Country code for USA & Canada +1) *

Country CodeArea CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
HP Supervisors Name (your FHCi practitioner)*

First NameLast Name
FHCi HP Supervisors Email*
example@example.com
I am enrolling in:*

1. Healthy Biome HPx2. Full Childhood Immunological HPx3. Young Adult and College Prep HPx4. Travel HPx5. Healthy Sexuality and Pre-Procreation HPx6. Healthy Pregnancy and Fetal Development HPx7. Immune Health for Seniors HPx8. Single disease prevention HPx
How many Children will be participating?*
How many Adults will be participating?*
Please enter your donation - $35 minimum Membership amount

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USDRemember ~ your FHCi dues are tax deductible. You may increase the amount to help us grow!
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Free and Healthy Children international Patronship Registration