EmailMe Form - Holistic Fashionista Chapters

Name *

First Last

Business Name *

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

If your application is approved, where shall we mail your marketing materials?

Email Address *

Phone *

### - ### - ####

In what city, state, country would your local chapter be?

What kind of events would you host as a Chapter Leader? *

Name of Your First Event: *

Headshot for your flyers *

High resolution files preferable.

Short bio for your flyers

40-60 words