I am interested in being a member of the Healing House Wellness Network. The information I have given will be used to help provide wellness referrals to Healing House clients.
I understand this is an application, which will be pending until approved or denied. Upon approval, a payment will be due for the amount of the membership period I have chosen, i.e. one month, one quarter, one year.
I have supplied accurate and true information to the best of my knowledge. The information about my business may be changed in writing by submitting a new Wellness Network Information form.