IPA Referral List Application

This is an application to be on a list of IPA members who represent themselves as offering primal work. You must be an IPA member to be included on the list. The listing will be published by the IPA and will include the following statement: "The following is a list of IPA members who represent themselves as offering primal work. The IPA does not endorse the expertise or experience of these individuals."

Name:	_____________________________________________________
Address:	_____________________________________________________
	_____________________________________________________
Zip/Postal Code:	___________________________
Country:	___________________________
Home Phone:	___________________________
Work Phone:	___________________________
Fax:	___________________________
Email Address:	_____________________________________________________
Website:	_____________________________________________________

 

Description of services and credentials: (Maximum 50 words)

The cost of a listing on our referral list is $40 (payable in US funds). Make your check out to the IPA. Send check and this completed form to:

International Primal Association
811 Whann Avenue
McLean, VA 22101

Questions? Contact Barbara at 248-478-5559 or babryan@twmi.rr.com