Membership Application

Membership Type*
- Individual Membership $150/Year
- Collaborative Membership $350/Year
Name*
First Last
Email*
Address*
Street Address Address Line 2 City State ZIP Code
Company Name (if applicable)
Business Description (if applicable)
Date of Birth*
Phone*
Website (if applicable)
How did you hear about us?
- Friend
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- Email
- Other
If Other, please explain
Empowerment Areas of Interest
Special Topics/Offerings you would like offered by SheBreathes
Would you like to refer an individual or collaborative member? (Please provide Name, Phone Number, Email)
Please click here to view the SheBreathes Code of Ethics
I have read and accept the SheBreathes Code of Ethics.*
- I have read and accept the SheBreathes Code of Ethics.
Digital Signature*
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