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Multi Unit application pg The Day Spa Association

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					                                                               $$
                                                               !
                                        The!Day!Spa!Association!
                                Multi4Location!Membership!Application!
                                                 2012!
                                                                                                               $

    Complete this form and fax a signed copy of your application to (855) 344-8990, scan/email it to
    dsa@DaySpaAssociation.com or mail a signed copy to: The Day Spa Association, 2863 Hedberg Drive,
    Minnetonka, Minnesota 55305-3406



    Contact Information

    Company Name:                 _________________________________________________________________________

    Primary Contact:              _________________________________________________________________________

    Profession/Occupation:        _________________________________________________________________________

    Main Location Address:        _________________________________________________________________________

    City, State, Zip Code:        _________________________________________________________________________

    Telephone:                    _________________________________________________________________________

    E-mail Address:               _________________________________________________________________________

    Web Address:                  _________________________________________________________________________

    Signature:                    _________________________________________________________________________
!
    !
$
    Membership Information!
    First location is $229, each additional location is $99!

    Total # of locations:         _________________________________________________________________________!
    !
    Total amount to charge:       _________________________________________________________________________!
    !
!
    Payment Information!

              ☐ MasterCard                  ☐ Visa                  ☐ American Express   ☐ Discover


    Credit Card billing address: ________________________________________________________________________
    (If different from above)

    Card #: ______________________________________________________________ Expiration: ________________
$
$

          Day$Spa$Association,$2863$Hedberg$Drive,$Minnetonka,$MN$55305?3406$$(877)$851?8998$
                                                              DSA$Membership$Application$
                                                                Multiple5Location$Spas$


Location Name                                                                           Primary Contact
Address                                                                                 Phone
City, State, Zip                                                                        Email Address
Circle one         Spa & Wellness    Medical Spa           International Spa



Location Name                                                                           Primary Contact
Address                                                                                 City, State, Zip
Phone                                                                                   Email Address
Circle one         Spa & Wellness    Medical Spa           International Spa



Location Name                                                                           Primary Contact
Address                                                                                 City, State, Zip
Phone                                                                                   Email Address
Circle one         Spa & Wellness    Medical Spa           International Spa



Location Name                                                                           Primary Contact
Address                                                                                 City, State, Zip
Phone                                                                                   Email Address
Circle one         Spa & Wellness    Medical Spa           International Spa



Location Name                                                                           Primary Contact
Address                                                                                 City, State, Zip
Phone                                                                                   Email Address
Circle one         Spa & Wellness    Medical Spa           International Spa




                                    If you have this information on your own document, we will accept that in the place of this sheet, as well
                                                                     (Please copy extra pages, if necessary)



                                      Day Spa Association, 2863 Hedberg Drive, Minnetonka, MN 55305-3406 (877)-851-8998

				
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