Spirit of Women

Rewards Partner Application Form

Acknowledgement

  • Rewards Partners agree to provide a discount or special offer to Susquehanna Health Spirit of Women members beginning on enrollment date and automatically renewed annually.
  • Rewards Partners may opt out but are required to give a 60-day notice to the Susquehanna Health Coordinator of Outreach Program. Should the discount or special offer described be unavailable, Rewards Partner will provide an incentive of equal or greater value. Susquehanna Health Spirit of Women Members must present their loyalty card to qualify for the incentive.
  • Rewards Partners will be listed in the Susquehanna Health Spirit of Women Membership Rewards directory, on the Susquehanna Health website, advertisements, newsletters and community events when deemed appropriate by Susquehanna Health Marketing Department.
  • Spirit of Women membership database information is confidential.
  • Rewards Partners may not use any Susquehanna Health logo or Spirit of Women logo without prior approval from the Marketing Department at Susquehanna Health.
  • Susquehanna Health Spirit of Women maintains the right to approve all Rewards Partners.

Fill out the form below to become a Rewards partner or download a print version. You may also register by calling Susan Browning at (570) 321-2921.

Fields with an * are required.

* First Name:
* Last Name:
* Email:
* Company:
* Address:
Address Line 2:
* City:
* State:
* Zip Code:
Phone:
Website:
*Signature:

Type in your full name to signify your acceptance of this application agreement.
*Are you or any members of your immediate family employed or serving as a board member, officer, or committee member at Susquehanna Health?
If yes, please list names and affiliation with Susquehanna Health:
Name 1:Position 1:
Name 2:Position 2:
Name 3:Position 3:
*What services or products does your company provide?
*What discount will you offer to Spirit of Women members?

No fee will be charged to partner with Susquehanna Health Spirit of Women. However, we do expect you will make every attempt to participate in at least one Susquehanna Health Spirit of Women event per year if invited. We may also ask you to donate a door prize in lieu of paying a vendor fee at events. If invited and you choose not to participate in events, we will require you to donate at least one give-away per calendar year valued at $50 or more to be used at Susquehanna Health Spirit of Women events.

*Will you be willing to participate in at least one Susquehanna Health Spirit of Women event per year (if invited) and/or provide at least one door prize per year valued at $50 or more?

Spirit of Women is a voluntary program offered as a convenience to members. The inclusion of any particular organization or business does not constitute our express or implied endorsement of any products or services.