Partnership Application

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Company Name *

Please provide your full legal company name for contract purposes. If you DBA a differnt name, please provide that as well for marketing purposes.

First Name *

Primary Contact Only Please

Last Name *

Department

Job Title *

Email *

Phone 1 *

Address Line 1 *

Address Line 2

City *

State/Province *

Zip/Postal Code *

Country *

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How did you hear about us? *

Please Describe

Company Website *

Please provide a brief business description (blurb) *

Please select the option that best describes your business category *

Please provide us with your social media handles/tags so we can like & follow your accounts. *

Upload your company logo *

Supporting Health4Heroes

The buy-in for this partnership is an exclusive discount to our members that helps improve access to your products and/or services therefore improving their health & wellness and reducing financial barriers.

The Discount: Please describe the services/products etc you wish to discount and include their discounted rate along with any additional terms (Offer must be exclusive to Health4Heroes Members) *

Example: 25% OFF Monthly Unlimited Membership. Offer cannot combine with any other special offers

Please add any other offers that you want to include in this partnership

example: 10 free class passes per year, 2 free memberships per year, free consultation, etc

Data Privacy & Consent

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Password

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Partnership Application