Corporate Partnership: Client Enrollment

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Please enter the information provided by your organization through email, direct mail, online portal or other sources to receive your Blue Moon Yoga & Wellness special pricing.

Email *

Your Organization *

Access ID, CCH Member ID # or Employee Number *

First & Last Name *

Phone Number *

Select Your Special Pricing Offer *

If you selected 20% off Membership above, please select which membership is right for you (memberships require a 3-month initial commitment then renew automatically month-to-month after the initial 3-month term):

Eligibility Acknowledgement *

By checking this box, I acknowledge that the information I provide here is true and accurate and that I meet all the eligibility criteria established by my Organization for participating in the Blue Moon Yoga & Wellness offering.

Required

A copy of your responses will be emailed to the address you provided.

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