Membership Application

Membership Type*
- Collaborative Membership $399/Year (monthly payment plan available)
- Virtual Collaborative Membership $299/Year (monthly payment plan available)
Name*
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Email*
Address*
Street Address Address Line 2 City State ZIP Code
Company Name (if applicable)
Business Description (if applicable)
Date of Birth*
Date Format: MM slash DD slash YYYY
Phone*
Website (if applicable)
How did you hear about us?
- Friend
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If Other, please explain
Empowerment Areas of Interest (topics you'd like to see offered)
Offerings You Hope to Bring to 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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