Items marked with * must be filled in. First Name: * Last Name: * Company: * Address: * Please fill in at least one of the following so we may contact you: Telephone: * Daytime Evening Fax: E-mail Address:* Do you make the decisions for wellness in your company? Yes No If you answered no, please specify who does. Approximately how many people work at your company? 1 to 9 10 to 24 25 to 50 50 plus How would you like us to contact you? E-Mail Mail Telephone Service/Program Please choose the services and programs offered by Vitality Services that you are interested in: Self-Management Workshops Nutritional Wellness Onsite Shiatsu Massage - Chair Tai-Chi Classes Kung Fu Classes Onsite Shiatsu Massage - Chair Stress Management Workshops Other (specify: ) How did you find out about Vitality Services? Search Engine. NewsGroups "Word of Mouth" I was referred by someone else. I saw a representative perform an Onsite Massage. I was looking for Wellness related pages. Other I was looking for Shiatsu related pages. If other (specify: ) OTHER: If there are any other services you may be interested in, please specify. info@vitalityservices.com Tel: (514) 582-7209 © 1999 Vitality Services. All rights reserved.
Tel: (514) 582-7209
