First Name

Last Name

Personal or Business Street Address

City

State

Zip

Phone

FAX

E-mail

Web Address

Type of Business

Business or Service Description
If you have a wellness related business or service, please provide a 75-word or less description as you would like it to appear in the membership brochure, publicity, etc. (NEW member or NEW information only)

Todays Date
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Membership Fee $25 membership fee payable to Huntingdon Health and Wellness Association.
Mail to Jennifer Breimhurst, Treasurer, 313 Fourth Street, Huntingdon, PA 16652.
Membership is required by the first Saturday in October to be listed in our glossy, color brochure. (approximately 500 printed annually)

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