| Membership Application Form |
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Membership Application For Fiscal Year Oct. 1, 2012 to Sept. 30, 2013 Huntingdon Health and Wellness Association (HHWA)
Name___________________________________________________________________________________________________________________
Business Address (if applicable) ______________________________________________________________________________________________
Street Address____________________________________________________________________________________________________________
P. O. Box________________________________________________________________________________________________________________
City__________________________________________________State________________Zip___________________________________________
Phone_____________________________________________________Fax_________________________________________________________
E-mail__________________________________________________________________Web Address ____________________________________
Type of Business (if applicable)_____________________________________________________________________________________________ Date ______________________________________________________
If you have a wellness related business or service, please provide a 75-word or less description as you would like it
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