FREE Wellness Directory Submission Form
The Complete Resource for Yoga, Health & Spirituality in B.C. Interior
Name of salesperson or person who referred you:
Your answer
Is this your first listing? *
Are you an Interior Wellness ambassador? *
Your answer
Business Name (if Applicable) : *
Your answer
Your Name: *
Your answer
Email: *
Your answer
Your answer
Your answer
Mailing Address:
please include your postal code
Your answer
Which Category would you like to be listed under ? *
please choose only one category
I'd like to suggest a new category for my listing
Your answer
Your Wellness Directory listing (Maximum 20 words business/contact info)
preferred format (20 words spread over 4 lines)
**up to 5 words per line** please include your city
your business/contact info spread over 4 lines *
Your answer
Please don't forget to send us your photo/logo
Never submit passwords through Google Forms.
This form was created inside of Interior Wellness.