TAGNW Wellness Application
Please apply to become a member of the TAGNW Wellness program by providing the basic information below, accepting the program terms and conditions, and electronically signing and submitting the application..

Please contact Michael Gan, TAGNW Executive Director, for any questions or comments at director@tagnw.org, 360-312-7105, or via private message at the TAGNW Community Hub @Michael Gan.
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First Name *
Last Name *
Phone Number *
Email Address *
Discord Username *
At TAGNW, we utilize the TAGNW Community Hub on the Discord online chat platform to create private sections for members and programs. Please sign in to the TAGNW Community Hub and provide your Discord username so that we can grant you access.  https://www.tagnw.org/community-hub
Why are you joining?
Please tell us, in your own words, what your reasons are for joining TAGNW Wellness, and what you would like to get out of the program.
TAGNW Wellness Terms and Conditions
By submitting and electronically signing this application, you are confirming you wish to be considered to participate in the TAGNW Wellness program.  You agree that you have read, understand, and either currently meet or will meet (before your first TAGNW Wellness meeting) the TAGNW Wellness program requirements at https://www.tagnw.org/wellness/.  You consent to the use of electronic signatures, and agree that your electronic signature is the legal equivalent of your handwritten signature on this agreement. The TAGNW Wellness program and its volunteers (collectively referred to herein as “TAGNW Wellness”) is not intended to diagnose, treat, prevent or cure any disease or condition.  The information and content provided by TAGNW Wellness is for informational purposes only, and it is not intended to substitute for an individual relationship with, or the advice, treatment and/or diagnosis of a qualified licensed professional.  TAGNW Wellness volunteers are not medical professionals, and may not make any medical diagnoses or claims, and/or substitute for your personal physician’s care.  TAGNW Wellness does not provide second opinions, or in any way attempt to alter the treatment plans or therapeutic goals/recommendations of your personal physician.  Do not disregard medical advice or delay seeking medical advice because of information provided by TAGNW Wellness.
Acceptance *
Electronic Signature *
Type your full name and today's date to sign electronically.  Example:  Jennifer Jones, 1/1/2022
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