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NEXT WELLNESS PASSPORT SEASON: SEPT 1 - NOV 2, 2025

the Wellness Passport

BECOME A WP BUSINESS

Please use Google Chrome or Safari to submit this form!

Contact Person First/Last Name

Contact Person Email

Contact Person Phone #

Business Name

Business Email

Business Phone #

Business Address

Business Website

Business Social Media Domain (link not just handle)

2-3 sentence elevator pitch about your business

What will you offer Passport holders?

How will Passport holders redeem this?

Are you interested in offering an end of passport raffle prize? If so, what will your prize be?

Are you interested in offering an end of passport deal? If so, what will your deal be?

Choose your business category

Sweat

Self Care

Savor

What are your business services?

Choose your city

Birmingham

Tuscaloosa

Huntsville

Great way for more foot traffic, brand awareness, etc.

Are you interested in being your city’s passport pickup location?

Yes

No

Upload Business Image

Select File

Please confirm the image is cropped to a square format.

Upload Business Logo

Select File

Please confirm the logo is cropped to a square format.

Your Signature

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