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HMN Membership Registration
Membership Option
*
New Member
Renewal
PLEASE NOTE: There is the option to add 3% to your total in order to cover processing fees at the bottom of this form. Just tick the box if you would like to do so. Thank you!
Membership Type
*
$45
-
1 Year Family Membership (allows a partner/spouse to attend all events)
$40
-
Recurring 1 Year Family Membership (renews annually automatically)
$175
-
5 Year Family Membership
$55
-
Community Organizer Onboarding Fee +1 Year Family Membership
$15
-
Community Organizer Onboarding Fee (I am already a member!)
***PLEASE NOTE: You will receive notification 60 DAYS PRIOR and 30 DAYS PRIOR to your automatic renewal, with the option to opt out, if you select the 'automatically renew annually' option***
This is a Gift
Yes
Gift From:
Select a Chapter (Primary)
*
select one
Unaffiliated
CA - Cucamonga Valley Chapter
CA - Greater Pasadena Chapter
CA - Sacramento/American River Chapter
CA - San Diego (North County) Chapter
CA - San Jose Chapter
CA - Santa Clarita Valley Chapter
CO - South Denver Chapter
CT - Fairfield County Chapter
CT - New Haven County (SW) Chapter
GA - West Atlanta Metro Chapter
IL - Chicago Area Chapter
IN - South Bend Area Chapter
LA - North Louisiana Chapter
MA - Northeast Chapter
MD - Montgomery County Chapter
NH - Hillsborough County Chapter
NJ - Camden, Burlington and Gloucester Counties Chapter
NJ - Essex County Chapter
NJ - Greater Princeton Area Chapter
NJ - Monmouth County (East) Chapter
NJ - Morris County Chapter
NJ - Sussex County Chapter
NJ - Ocean County Chapter
NY - Manhattan and Westchester County Chapter
NY - Sayville Chapter
SC - Lexington Chapter
VA - Central Virginia Chapter
VA - Northern Virginia Area Chapter
WI - Lake Country Chapter
WI - Milwaukee Chapter
Name of newly forming chapter
Special Code
Contact Information
Name
*
First Name
Last Name
Address
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
County
Email
*
(This email will be used to invite you to our national Facebook members' group, and your local chapter's Facebook and/or Google group. We also send occasional emails from both your chapter and national organization.)
Verify Email
*
Alternative Email
Verify Email
Cell Phone
Home Phone
Work Phone
I am on Facebook
*
All HMN members can join the HMN members-only Facebook closed group, as well as local Chapter Facebook groups and email loops. (Watch for email invite within 7-10 days of joining)
Yes
No
Is your Facebook profile name different from the name provided? If so please put it in the box below.
If your profile name differs please note it here so we are able to more easily approve you into the HMN Facebook groups for active members. Thanks!
Spouse/Partner name (for family membership)
First Name
Last Name
Spouse/Partner Email (for family membership)
Verify Email
I am interested in volunteering
Yes
Referred by - If an Active HMN Member referred you to HMN they receive a one month extension on their membership!
First Name
Last Name
Agreement
*
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. 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.
Free Gift Offers
MABEL'S LABELS FREE CUSTOMIZED GIFT
*
Mabel's Labels is offering our new and renewing members a
FREE Birthday Party Label Pack!
Mabel's Labels are 100% guaranteed to stay put through the laundry, dishwasher and microwave. By selecting 'Yes' you understand that Mabel's Labels will receive your address information in order to ship the items directly to you. Please allow up to 6 weeks for delivery.
Yes
No thanks
Name on label
Please enter the name you would like printed on the labels
Mabel's Labels Icon Choice
Go to the link above and then click on the + sign next to 'CHOOSE DESIGN' to see all of the icon and palette choices, then make your selection here:
select one
No Icon
Ballet
Baseball
Basketball
Bee
Cake
Butterfly
Cactus
Canada Flag
Candy
Cat
Construction
Car
Carnival Snacks
Chameleon
Cheerbow
Cheerpose
Comic Book
Curling
Cupcake
Dino
Dogs
Donut
Elephant
Flamingo
Firetruck
Fairytale
Flowers
Football
Frog
Fox
Giraffe
Hockey
Heart
Horse
Jersey
Koala
Lacrosse
Lion
Llama
Mermaid
Monkey
Music
Narwhal
Owl
Pineapple
Polar Bear
Rainbow
Robot
Rocket
Sea Turtle
Shark
Skates
Ski
Sloth
Soccer
Stars
Super Heroes
Swim- Purple
Swim - Teal
Tennis
Tiger
Train
Unicorn
American Flag
Video Game
Watermelon
Weather
Whale
Boho Rainbow
Brain Freeze
Puppy Love
Making Magic
Boho Butterfly
Mabel's Labels Color Choice
Go to the link above and then click on the + sign next to 'CHOOSE DESIGN' to see all of the icon and palette choices, then make your selection here:
select one
Default
Black
Red
Orange
Yellow
Green
Blue
Purple
Pink
Play
Tropical
Hopscotch
Popsicle
Lake
Standard
Monochrome
Bubblegum
Puddles
Pigtails
Gumdrop
Shipping Address
Is your shipping address the same as the address above, on your registration form?
Yes
No
Shipping Address
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
KNOWEWELL INDIVIDUAL EXPLORER ACCESS
*
KnoWEwell
is offering our new and renewing members
Individual Explorer access
to their Regenerative Whole Health Hub, a $60 annual value. KnoWEwell’s mission is to transform healthcare through its Regenerative Whole HealthTM (RWH) Hub—the global, trusted digital ecosystem, community, and marketplace collaborating to inspire hope and empower you with today’s RWH knowledge, evidence-based resources, and provider and organization connections, and education to proactively prevent harm, address chronic diseases, and help you thrive. By selecting 'Yes' you understand that KnoWEwell will receive your name and email information (only) in order to sign you up for your individual basic access.
Yes
No thanks
FULLSCRIPT DISCOUNT
*
Fullscript
, in partnership with HMN, is offering our new and renewing members a 15% discount on all orders. Our volunteer Community Organizers receive a 30% discount on all orders. Fullscript is an online dispensing platform that ships supplements to your front door. Fullscript provides: Professional grade brands and supplements for less, never counterfeit or expired, always stored and shipped correctly, automatic refill reminders for when life gets busy, optional autoship feature so you’ll never run out, ships directly to your door, free shipping over $50. By selecting 'Yes' you understand that Fullscript will receive your name and email information (only) and you will be invited to join our HMN Fullscript site.
Yes
No thanks
Please take a moment to tell us about yourself, so we can better tailor our Holistic Moms Network programs to suit your needs.
Your Age
select one
29 or under
30-40
41-50
Over 50
Your Gender
select one
Female
Male
Number of Children
select one
0
1
2
3
4+
How old are your children?
Check all that apply
No Children
Newborn - 2
3-5
6-10
11-18
Over 18
Practitioner
*
select one
Yes
No
If you are a practitioner, select your profession
select one
Acupuncturist
Blogger
Childbirth Educator
Chiropractor
Doctor of Homeopathy
Doctor of Naturopathy (ND)
Doctor of Osteopathy (DO)
Doula
Fitness
Holistic Health Counselor HHC
Lactation Consultant/IBCLC
Massage Therapist
Medical Doctor (MD)
Midwife
Nutrition
Other
Reiki/Energy Healer
RN
Yoga Instructor
Other profession
What activities are you, or would you like to be, involved with?
Gatherings
Playgroups
Email Loop
Facebook Group
National Conference
Outings
Support Network
Co-op
Fundraising
Other
If you checked "other", please describe
When can you, or do you, attend gatherings?
Check all that apply
Daytime
Evening
Weekdays
Weekends
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
If you checked "other", please describe
How did you hear about HMN?
Check all that apply
Email/Evite
Flyer
Internet Search
Membership Referral/Word of Mouth
Facebook page
Facebook group
Instagram
Mailer
News/Media - EcoParent Magazine
Mercola.com
Holistic Practitioner
Twitter
Other
If you checked "other", please describe
Add 3% to my total amount to help cover the payment processing fees