MEMBERSHIP APPLICATION FORM

Make Checks Payable to: Wisconsin Health Freedom Coalition

PO Box 53, Sheldon, WI 54766

PLEASE PRINT

TITLE: __________________________________________________________________________

FIRST NAME: ____________________________________________________________________
 

LAST NAME: ____________________________________________________________________

ADDRESS: ______________________________________________________________________

CITY: ___________________________________________________________________________

STATE: _________________________________ ZIP: _________

CELL PHONE:______________________________________________________________________

YOUR WI STATE SENATOR: _________________________________________________________

YOUR WI STATE ASSEMBLY REPRESENTATIVE:________________________________________

E-MAIL ADDRESS: _________________________________________________________________

MEMBERSHIP DUES: See next page for descriptions

YOUR SKILLS AND FIELDS OF INTEREST:

WIHFC Membership Category Descriptions

WIHFC membership consists of “complementary” health care providers such as herbalists, naturopaths,

homeopaths, colon hydrotherapists, acupuncturists, massage therapists, chiropractors, as well as

“conventional” providers, such as physicians, nurses, and social workers. Other providers of healthcare

services such as health food stores, multi-level marketers of natural health products, conventional and

complementary publishers, marketers and others devoted to complementary access are also encouraged to

join us in our mission. In addition, we also have many members with no formal background or training in

the health disciplines that join because they use complementary approaches and believe in learning how to take

care of their own health. They are really health care providers too, providers of their own health care and

that of their families.

1. Consumer – Those who utilize contemporary and complementary health approaches,

wish to learn more about its benefits, and/or believe and support the consumer's

right to choose complementary health modes as part of their total health care regime.

Included are patrons of health food stores; clients of health practitioners not

interested in voting privileges, but interested in information and supporting

organizational efforts.

2. Student – Full or part-time students at K-12 or College levels, interesting in

participating in LHFC activities and serving on committees. Students will have

voting privileges.

3. Individual – Patrons, clients, or any interested individual supporting the aims of

the WIHFC and wishing to be actively involved in advocacy and promotional

activities. These members have voting and office holding privileges.

4. Professional – Reserved for health care practitioners. All complementary therapists who

consider themselves practitioners are encouraged to join at this level. This

includes practitioners of Mind-Body Medicine such as hypnosis, Complementary

Medicine Systems such as naturopathy, colon hydrotherapy, Lifestyle Disease

Prevention, Biologically-Based Therapies such as herbalism, Manipulative Body-

Based Systems, such as chiropractic massage, Biofield Therapies, and

Bioelectromagnetics. Membership is also open to allopathic practitioners who

support a consumer's right to choose complementary medicine, incorporate it in their

practice, refer clients to complementary practitioners and/or wish to learn more about the

benefits of complementary medicine. This category is also appropriate for marketers,

lecturers, authors, and publishers specializing in promoting complementary practitioners and

therapies, professional sales persons specializing in natural health products, and

other professionals dedicated to natural health and/or freedom of access to these

services and products. Professionals have voting and office holding privileges.

5. Corporate – is usually utilized by health-related businesses such as health clinics,

complementary education centers or schools, health food stores, and manufacturers and

distributors of natural health care products. Corporate member representatives

and voting privileges are limited by membership sponsor level, as indicated in the

Dues Table.