Directory Listing FORM

LOS ANGELES ALLIANCE FOR CHILDHOOD
ADVOCATING A NATURAL APPROACH TO RAISING CHILDREN
A Project of Social and Environmental Entrepreneurs (SEE), a 501(c)(3) Public Charity

ONLINE DIRECTORY LISTING FORM (Click Here for a printable version)

If you are a practitioner and would like to be listed in our WCAN Resource Directory please contact us and request an information packet.

This form is for Businesses that wish to be listed in the WCAN Directory.

1. Please list my business under the following modality in the Whole Child Awareness Network (WCAN) Resource and Referral Directory:

The following is a list of all the MODALITIES in their CATEGORIES

CATEGORY MODALITY
ALTERNATIVE EDUCATION Home Schooling, Waldorf Education,
ARTS/MUSIC/MOVEMENT Art & Crafts, Dance, Eurythmy, Nurturing Art, Pilates, Theater, Yoga,
CHILDREN WITH SPECIAL NEEDS Remedial Education,
ENVIRONMENTAL AWARENESS Nature Exploration,
FAMILY SUPPORT Counseling, Empowerment, Family Constellation Work,
HEALTHY LIVING Cooking Classes, Cultured Foods, Feng Shui, Food Safety, Gardening, Nutrition Counseling, Organic Food Distributors, Sustainable Living,
HOLISTIC HEALTH CARE Acupressure, Acupuncture, Anthroposophical Medicine, Aroma Therapy, Bach Flower Remedies, Chiropractic Care, Cranial Sacral Therapy, Energy Work/Hands on Healing, Essential Oils, Flower Essences, Herbology, Holistic Dentistry, Holistic Medical Doctors, Home Health Care, Homeopathy, Massage Therapy, Naturopathic Medicine, Oriental Medicine and Nutrition, Osteopathic Medicine, Pediatric Care / Practitioner, Polarity Work, Reflexology, Reiki, Watsu/Aqua Therapy, Women's Health Care,
PARENTING Child Development, Importance of Play, Media Literacy, Parenting, REI Pickler,
PREGNANCY & BIRTH Doula, Midwifery, Pregnancy & Birth,

LEVEL 1 Benefits
Choose ONE modality from the above list (right hand column)

LEVEL 2 Benefits
Choose a SECOND modality from the above list (right hand column)

Please enter a description of 35 words or less to be included on the appropriate pages.

2. The Payment Schedule I prefer is:              (Payments payable to SEE/LAAC)

LEVEL 1:
$150
$170 Level 1 with logo

LEVEL 2:
$200
$220 Level 2 with logo

I authorize SEE/LAAC to receive the following WCAN Directory Listing fee from my account

Note: Payment will be drawn by SEE on the 15th day of the month.
        My preferred method of payment is:

Automatic CreditCard Draft

Charge my
Visa MasterCard Discover/Novus
Name on Card:
Card #:
Exp. Date:
Automatic Bank Account Draft

Name on the Account:
Account #:
Bank Routing #:
Bank Name:

· For further questions please call (626) 798-1592

So that we may Contact You

Name:

Company Name:

Address:

City:

State:

Zip:

E-Mail Address:

Web Site Address:

Phone #:

Please use this area for notes or comments you would like to make.

Thank you for your COMMITMENT

Click here to see other ways to become involved.