Spirit of Women

Membership Application Form

Fields with an * are required.

3 Ways to Join Spirit of Women

  1. Download the membership form, print it and mail it.
  2. Call 1-888-720-8461.
  3. To get the most out of your Spirit of Women experience, create an online account and complete the form below.

Reap the benefits of an online account:

  • Access a list of the most current exclusive retail discounts
  • Be the first to know about upcoming events and promotions just for women
  • Collect heart-healthy, mouth-watering recipes
  • Receive exclusive, age-specific health tips
Title:
* First Name:
* Last Name:
* Email:
Password
(If you've provided your own email and would like an account,
please enter a password. Or if you have another Susuehanna Health
account and would like to add access, please enter your
email/password you normally use. Otherwise leave the field blank)
* Address:
Address Line 2:
* City:
* State:
* Zip Code:
Phone:
Date of Birth:
*Are you a Susquehanna Health employee?
If yes, department?
*Are you employed by a Lycoming County School District or Penn College?
*Do you consider yourself a current Susquehanna Health patient/client?
If yes, which of the following services do you currently use?



Number of children in your household under the age of 18:
Email Newsletter:
My Interests:



By joining Spirit of Women and/or participating in Spirit of Women programs and events, I agree to waive any and all claims against Susquehanna Health, its employees, directors and officers, all sponsors, their representatives and any successors from any all claims or liabilities of any kind arising out of my participation in this program or any related activities. For Susquehanna Health privacy policy, log onto www.SusquehannaHealth.org.

Can't access your account? If you are already a Spirit of Women member, but don’t have an online account or are experiencing a problem, please contact us.