New England Holistic Health Association 2011/2012 Welcome!
Name *
Business Name *
Business Address *
Phone Number *
Fax Number
Email
Website *
Main Practice Modality *
Description *
Additional Modalities
Modality 2
Modality 3
Modality 5
Modality 4
Credentials
Licensed in:
State
License Number
Expiration
OR Describe in detail:
Volunteering
How are you willing to help out NEHHA?
Organize
Events
Staff
NEHHA booth at events/fairs
Membership
Drives
Public
Relations
Board Member
Other
Other
How did you hear about NEHHA?
How can we improve NEHHA?
Your comments, please:
Membership Terms and Code of Ethics
Acceptance of terms of membership and NEHHA member code of ethics. *
Yes
After Submitting Form
When you have completed this form please submit it. You will then be directed to a membership options and online payment page. To pay by check please download
the "NEHHA Membership Package Options 2011"
Payment Options *
Pay online
Pay by check
