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Co-op Regional Marketing Postcard
Are you planning on either attending an event with us OR cannot be present but would still like us to represent you? Please fill out this form to have your personal business information printed alongside others in your area on a single postcard that will be available for take-away at our booth at conferences in or around your region. This will benefit you in standing out as an individual in the local community as well as support participants in becoming aware of practitioners in their area. Please note that your certification(s) must be up-to-date to be included and that the cost of printing the cards will be split between those who choose to be listed. You will be billed accordingly. (Not to exceed $25 per person)
Date
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Name: *
Please enter your name as you would like for it to appear on the postcard.
Your answer
Which event are you attending? *
Please tell us which event you are attending.
PRYT Credentials: *
Check all that apply.
Required
Business Name (if different from your own name):
Your answer
Business Location: *
Please list the city and state where you practice.
Your answer
Professional Phone Number:
Your answer
Professional Email:
Your answer
Professional Website:
Your answer
Specialty Population(s):
If you work with any specialty populations, please list them here.
Your answer
Other Credentials:
If you have other degrees or liscensures that are relevant and that you would like listed, please indicate them here.
Your answer
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