WU World-Changer Application Date* Date Format: MM slash DD slash YYYY Name* First Last IMPORTANT: This form will generate your profile. Enter your FIRST and LAST name as you want it to appear on your profile. Your name and handle that appears publicly on The Wellness Universe STARTS HERE. Double check all fields before you submit. Thank you!Phone*Address* Street address, P.O. box, c/o. Apartment, suite, unit, building, floor, etc. City State/Province ZIP/Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Company or Organization Name*Briefly Describe What You Do*Years of Experience in Your Field*I am happiest when ....*What does success look like to me ....*As a Wellness Universe Member, how do you see yourself?*What inspires you most from what you have seen/heard/read about WU?*What are ways you can give in a community?*You Offer*ProductsServicesProducts & ServicesI Enjoy My Work As a*Check all that apply. Coach - Individuals Coach - Groups Coach - Organizations Book Author Blogger Video Content Creator Podcast Host Podcast Guest Public Speaker Panel Participant Panel Moderator Workshop Facilitator Online Course Provider Online Services Provider In Person Services Provider Virtual Events Creator Virtual Events Presenter In Person Events Creator In Person Events Participant Corporate Wellness Specialist Participant in Collaborative Projects Certification Specialist Teacher Mentor Volunteer You Are Interested In*You currently do not offer, but are interested or plan to offer, check all that apply. Coach - Individuals Coach - Groups Coach - Organizations Book Author Blogger Video Content Creator Podcast Host Podcast Guest Public Speaker Panel Participant Panel Moderator Workshop Facilitator Online Course Provider Online Services Provider In Person Services Provider Virtual Events Creator Virtual Events Presenter In Person Events Creator In Person Events Participant Corporate Wellness Specialist Participant in Collaborative Projects Certification Specialist Teacher Mentor Volunteer Email* Enter Email Confirm Email Please be sure your email is accurate. Double check it is typo free and one you check often. Please add [email protected] to your email safe list to receive your approval email. Please submit the following:Video URL* Where can we see a video or interview of you? Link to testimonials, recommendations, or reviews* Where can we see client reviews of you or your business?Business Facebook URL (or equivalent social media link)* Business LinkedIn URL (or equivalent business social media link)* Your Website URL* Business Blog URL Were you invited to WU? Enter name of the person who referred you or tell us how you heard about us*Verify* Yes, I understand and agree By clicking this box, you understand your submission of this application will begin the review process. We will review what you have submitted and may also research references based on your submission. If approved, you will be notified via email from [email protected] (Please add this email to your safe folder). You must select a membership to be a Wellness Universe World-Changer member. You are required to fill out your profile completely and accurately within the first 30 days upon approval. If you do not hear from us within 30 days, please email us. You are welcome to email us upon submission to verify we received your application. ALL CONTENTS OF THIS APPLICATION IS PRIVATE AND USED FOR SOUL VENTURES DBA THE WELLNESS UNIVERSE TO REVIEW YOU FOR MEMBERSHIP IN TheWellnessUniverse.com HumansEmailThis field is for validation purposes and should be left unchanged.
