Health Journeys - Resources for Mind, Body, and Spirit

Become a member of the Health Journeys Professional Program!

Professional Program Application
To become a member of the Health Journeys Professional Program we require a complete and accurate application. Your application will take approximately 1-3 days to process and responses will come via e-mail or phone. Please fill out the information below and fax or mail it to us.

Business Name : *

Name of Applicant: *

Last:

First:

Street Address: *

Street Address(2):

City: *

State:

State/Province:
(if not in US)

Postal Code: *

Country: *

Telephone #: *

Fax #:

Email Address: *

I would like to receive your FREE e-Newsletter

Web site: http://

Username: *

Password: *

SELECT ONE:

Ownership Corporation Partnership Individual

Year Established:

Applicant SSN#:

Federal I.D.#:

Tax Exempt: Yes No (If Yes, Please fax us your certification)

How will you Distribute/Sell our products?

**Submit a copy of this application with a copy of your letter head to the address below.

healthjourneys
Attention: Nancy Kohler
891 Moe Dr. Suite C
Akron, OH 44310

330.633.3831 local
800.800.8661 toll free
330.633.3778 fax
nkohler@healthjourneys.com

http://www.healthjourneys.com

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The most divine art is that of healing.
--Pythagoras