PRACTITIONER SUBMISSION We would be honored to add you to our amazing directory of holistic health care practitioners. Please submit the following information: *required First Name : * Last Name : * Email : * Phone : * Clinic website : * Name of your Standard Process representative : * Professional Training (check all that apply) : * Acupuncture Acupressure Ayurveda Chiropractic Homeopathy Naturopathy Massage therapist Osteopathy Qigong Reiki Reconnective Healing Other: (Explain) Name the Standard Process Whole Food Nutrition Seminars you have attended in the past : * Have you attended Gerald Roliz’s "Nutritional Therapy in a Pharmaceutical World" seminar before? * Yes No Are you interested in a bulk order purchase for The Pharmaceutical Myth at wholesale to distribute to your clients/patients? * Yes No Number of books interested in purchasing: Security Code : *