Retailer Application Form
This form is to be filled in by health shops and pharmacies selling companies of natural health products. Information supplied must be filled in by the person duly authorized to receive TNHA communications, and with whom we will liaise with.
Once we have received your complete application form, one of our representatives will contact you and send you an invoice for payment for your annual membership fee along with banking details. When your fees have been received, you will be sent your Membership Certificate, welcome letter and receipt.
Please fill in your first name.
Surname / Last Name
Please fill in your surname or last name.
Shop / Company Name
Contact Email Address
Please fill in your email address.
Company Postal Address
Where can we send your membership certificate and receipts to.
In which Province is your company headquarters located?
Outside South Africa
Company Telephone Number
Please fill in your telephone contact number (include dialing code)
Type of Company
What type is company do you represent?
Health Shop (R1,500.00 per year membership fee per store)
Pharmacy (R1,500.00 per year membership fee per store)
Online Retailer (R1,500.00 per year membership fee)
Direct Seller / Multi-level Marketer (R750.00 per year membership fee)
What type of natural health products do you sell?
Let us know what type of products you sell. You can make more than one selection.
We sell food supplements (vitamins, minerals, amino acids, probiotics etc)
We sell herbal products.
We sell homeopathic products.
We sell super foods.
We sell natural skin products and cosmetics.
Other innovative natural products (not listed above)
Would you like to volunteer to serve on the Retailer Working Group?
We need volunteers from your industry to serve on the Retailer Working Group?
Would you like to receive our monthly newsletter keeping you informed on regulatory issues?
Would you be interested in advertising in our newletter and/or social media pages?
We reach 25 000+ health stores, pharmacies, natural health practitioners and health conscious consumers each month, plus another 40 000+ social media followers each month.
Are you currently a member of the Health Products Association of South Africa
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service