May Membership Drive: Discount Deducted at Payment Page
Please complete the form below and click the Submit button to complete your membership, paying by credit card or using a PayPal account. Registration will not be complete until payment information is entered and a notification of payment is received from PayPal. Please complete the entire process, including online payment, to obtain your HMN Membership. As membership serves as a contribution to our non-profit organization, membership fees are non-refundable. Once payment is received and processed, there will be no refunds due to Chapter closings, financial hardship, or similar circumstances. All National benefits of membership will continue regardless of affiliate Chapter status.
Click here if you're an active member and want to apply to become a Chapter Leader or Co-Leader.
Fields marked R are required.
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Membership Options
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First Name R
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Last Name R
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Primary E-mail Address R
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Alternate E-mail Address
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Address 1 R
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Address 2
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City R
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State R
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Country R
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Home Phone R
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Work Phone
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Cell Phone
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County R
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Chapter R
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Second Chapter Membership (Annual) Reset
Choose one of the following and then select a second chapter.
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Additional Donation to HMN
$
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Coupon Code
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Comments
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Agreement R
I understand and agree to the terms of HMN's non-solicitation/non-marketing policy. As a member I am not using my membership to sell any product or service to other members or to help any individual build their business through the HMN community. If I violate this policy for the sake of business promotion or sales I will forfeit my membership.
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Please take a moment to tell us about yourself, so we can better tailor our Holistic Moms Network programs to suit your needs.
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Your Age R
Your Gender R
Number of Children R
Practitioner? R
If Yes, Profession
Other Profession
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Which activities are you involved with?
(Check all that apply)
Meetings
Playgroups
Email Loop
Annual Conference
Outings
Support Network
Co-op
Fundraising
Other:
 Special Bonus:R Included in your registration is a 1 year subscription to Organic Gardening - $10 value. See below for refund details.
Yes - I want it.
No.
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How old are your children?
(Check all that apply)
No Children
Newborn - 2
3 - 5
6 - 10
11 - 18
Over 18
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When do you attend meetings?
(Check all that apply)
Daytime
Evening
Weekdays
Weekends
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What are your areas of interest?
(Check all that apply)
Healthy Eating/Organic Food
Alternative Health
Breastfeeding
Natural Childbirth
Stress Reduction/Exercise
Vaccination
Holistic Education
Environment
Sleep Issues
Attachment Parenting
Fighting Consumerism
Spirituality
Parenting Multiples
Political Activism
Other:
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How did you hear about HMN?
(Check all that apply)
Email/Evite
Flyer
Internet Search
Member Referral/Word of Mouth
Facebook
Mailer
News/Media
E Magazine
Organic Spa
Brain Child
Mercola.com
Holistic Practitioner
Twitter
Other:
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If for some reason you do not want the magazine, you can obtain a $10 refund by printing out this form with your name and address and sending it along with your proof of membership to: Rodale Rebate, PO Box 26299, Lehigh Valley, PA 18002-6299.
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