HANA : Healing Arts Network Association

Healing Arts Network Association Membership Renewal Application
2006 - 2007

The information provided on the Membership Renewal Application will be added to the official Healing Arts Network Association members list. This information will be openly shared with other HANA members on a need to know basis. This information will not be shared or sold commercially.

Required fields are in bold.

Name (First/MI/Last):

Organization:

Address Line 1:

Address Line 2:

City:

State:

Zip Code:

Home Phone:

Work Phone:

Fax:

Cell:

Pager:

Email:

Most communication within HANA is sent electronically. (This includes minutes of Leadership Council Meetings, newsletter, calendar events, etc.) If you don't have an e-mail address - your communication will be sent via regular mail.

PRACTITIONERS - are individuals who supply health related services
SUPPORTERS – are individuals who do not supply health related services
AFFILIATES – are Not-For-Profit organizations or groups

Membership Type:

1. The Directory of Practitioners is published on an annual basis and routinely distributed throughout the community during the year. (Health food stores, business, health fairs, workshops, seminars, educational settings, etc). If you would like your business listing to be included in the 2007 Directory of Practitioners, the following information must be submitted no later than September 30, 2006.

2. You may also choose to be listed on the HANA Website, which has been professionally developed and promoted.

In Addition to my membership, I want to be listed in:

(If you selected None - Stop Here - Go to the bottom of this form and submit your renewal form)

PRACTITIONERS LISTING ON THE WEBSITE AND/OR IN THE DIRECTORY OF PRACTITIONERS:
ONLY COMPLETE the items, which you want included in your listing

Check box to copy information from above

Days/Hours of Services:

Website:

Name (First/MI/Last):

Organization:

Address Line 1:

Address Line 2:

City:

State:

Zip Code:

Home Phone:

Work Phone:

Fax:

Cell:

Pager:

Email:

Select all modalities under which you would like to be listed:

Acupuncture	Emotional Freedom Technique (EFT)	Personal and Professional Coaching
Alexander Technique	Feng Shui	Polarity Therapy
Applied Kinesiology (AK)	Fitness and Exercise	Raindrop Technique
Aromatherapy	Healing Touch	Reflexology
Ayurveda	Herbal Therapy Consulting	Reiki
Bach Flower Remedies	Hypnosis/Hypnotherapy	Synergy Dance
Brennan Healings (Energy)	Massage	Synergy Yoga
Chiropractic	Meditation	Tai Chi
Clinical Kinesiology (CD)	Myotherapy	Thought Field Therapy (TFT)
Counseling and Psychotherapy	Neuromuscular Therapy	Yoga
CrainoSacral Unwinding	Nutritional Therapy	Health Care Products
Creative Arts Therapy	Pastoral Counseling	OTHER
OTHER: - If the modality that you provide is not listed, please list it with a short description, You may, also, include a supporting website. LIMIT 50 words.

The following information will be included in your listing in the Directory of Practitioners and/or Website, the 2 paragraphs should not exceed 100 words

Paragraph 1. Credentials / Education / Experience
Paragraph 2. A Description of your services / product(s)

Please indicate whether or not you will offer a 10% discount for services and products to HANA members through September 30, 2007:

Additional Comments (optional):

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