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$25 per directory issue gives you: For online form submission go back to "Get Listed" and click on "Online Submission". Or you may copy and paste this form into email and submit your listing online at contact@athenswellness.com Please include: Name: ___________________________________Phone: __________________ email: __________________ Category(ies) you wish to be listed under: (ex: massage therapy, chiropractor, acupuncture, yoga instructor) Professional References: (please give three) 1.____________________________contact info: _______________________________ 2.____________________________contact info: _______________________________ 3.____________________________contact info: _______________________________ Payment: Check: ______________Cash: ____________ Credit Card: _______________________ Exp: _____
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