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Membership Intake Form
airosuites
2024-09-02T21:04:34+00:00
Membership Intake Form
Please complete the membership intake form below to begin your onboarding process.
Name
(Required)
First
Last
How would you like your name to appear in the virtual receptionist?
(Required)
This is how your clients will see and select your name in our virtual receptionist system. Ex: Kyle Chowning, LPC-MHSP
Company Name
Please provide the name of your company. If you are a sole proprietor doing business under your own name, this is not required.
Employee Identification Number
(Required)
Please provide your federal Employee Identification Number. If you do not have one, please provide your Social Security Number.
Address
(Required)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Email
(Required)
Mobile Phone
(Required)
This number will be used to send you your personal access code for entry and will also be used by our virtual receptionist to notify you via text message when a client is waiting.
Website
(Required)
Is your business registered with the State of Tennessee?
(Required)
Yes
No
Is your business registered with the city of Hendersonville?
(Required)
Yes
No
Proof of Liability Insurance
All tenants are required to provide proof of a $1,000,000 liability insurance policy with Airo Therapy Suites listed as an additional insured. If you have this document ready, please upload it here. If not, please send proof of insurance prior to your start date. We will follow up with you after submission if necessary.
Accepted file types: jpg, gif, png, pdf, Max. file size: 50 MB.
Membership Options
On what date would you like your membership to begin?
(Required)
MM slash DD slash YYYY
Which day(s) are you wanting to start your membership with?
(Required)
Choose all that apply
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
What is your preferred suite?
(Required)
Suite 1 - Unavailable
Suite 2 - Unavailable
Suite 3
Suite 4
Suite 5
Suite 6
Suite 7
I don't have a preference
What is your next preferred suite?
(Required)
Suite 1 - Unavailable
Suite 2 - Unavailable
Suite 3
Suite 4
Suite 5
Suite 6
Suite 7
I don't have a preference
Do we have your permission to use your name for promotional purposes? We will always seek your approval before any use.
(Required)
Yes
No
How did you hear about Airo Therapy Suites?
(Required)
Google Search
Social Media (Facebook, Instagram, etc.)
Referral from a Friend/Colleague
Online Advertisement
Walked by/Local Signage
Networking Event
Professional Association or Group
Website/Blog
Yelp or Other Review Site
Other
Please share how you heard about us
Is there anything you'd like to ask?
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