Health and Active Listing Form

Your almost done!

Just give us a few of your details and you’ll soon be part of Health and Active directory.

If you are having any hassles with our online application, please email us at: and we will add you the good old fashion way.

Name of business: (required)

Logo (provided in JPEG, JPG PNG, BMP): (required)

Description of business (up to 450 words): (required)

Our Services: (required)

4 images of business (formats accepted JPEG, JPG, PNG, BMP - no bigger than 500MB in size for each image): (required)

Please select the categories under which your listing should fall: (Max 4 categories required)

Healthy (click here...)

21 Day ChallengeAssesmentBiokineticsDietitianEating PlansHerbalife DistributorMassageSupplementsWeight Loss

Active (click here...)

BiokineticsBootcampsCrossfitDancingFitness DevicesFunctional TrainingGymsHiking TrailsKarateKids ActivitiesPark RunsPersonal TrainersPilatesSports MassageStreet WorkoutsYoga

Lifestyle (click here...)

Things To DoBachelorette PartiesBridal ExposBusiness ServicesEating PlansEventsExposFinancial PlanningGadgetsGetawaysHerbalife Business OpportunityKiddy FriendlyPetsPhotographyShowsSpa'sToys – Adults
CateringConferenceKids Party

Restaurants (click here...)


Accommodation (click here...)


Shopping (click here...)

Business ServicesClothingEating PlansEquipmentFitness DevicesOrganic MarketsOrganic ShoppingSkin CareToys – Adults

Medical Services (click here...)

BiokineticistsChiropractorsDentistryDietitianHyperbaric ChamberMommy DoctorsOccupational TherapistsOptometristsPhysiotherapyPsychologistSpeech TherapySports Massage

Alternative Health (click here...)

AcupunctureAromatherapyAstrologyAyurvedaComplementary MedicineFire WalksHerbal MedicineHomeopathyHypnosisIridologyKinesiologyMassageMeditationReflexologyReikiYoga

Beauty (click here...)

AestheticsBeauty SalonsHair RemovalNail BarsSpa's

Contact number: (required)

Email address: (required)

Physical Address (click here...)

- street number:

- street name:

- Suburb, City, Province:


Social media links: (click here...)

- twitter

- facebook

- google plus

- pinterest

- dribble

- vk

- instagram

- linkedin

- tumblr

- github

- flickr

- skype

- youtube

- vimeo

- vine

- xing

- yelp

Agreement for Internet Advertising Services (click here...)(required)

This agreement for internet advertising services (the “Agreement”) is made and effective -
BETWEEN: Health and Active (the Advertising Service Provider)
AND: (the Customer)(required)

In Consideration of the terms and covenants of this agreement, and other valuable consideration the parties agree to the following:

1. The Advertising Service Provider has the right to approve or reject, in its absolute discretion, the content of any advertising material that the Customer submits.

2. The Advertising Service Provider will retain all proprietary rights to its respective sites and other proprietary materials.

3. The Advertising Service Provider reserves at its own discretion all decisions and matters concerning placement of the Customer’s advertisement on pages of the Advertising Service Provider site.

4. The Customer hereby grants the Advertising Service Provider a non-exclusive licence to use the advertising material provided and the right to hyperlink to the Customer’s site from its site during the term of this Agreement.

5. The Customer represents and warrants that the advertising provided is not false and misleading, does not contain any untrue, defamatory, harmful, abusive, vulgar or obscene materials, is in compliance with all applicable laws, does not infringe upon the rights of any other party, including but not limited to copyrights, trademarks, privacy rights, moral rights, trade secrets, patents and any other rights. The Customer also warrants and represents that it has the unrestrictive and exclusive right to use all such materials.

6. The Customer may periodically request changes to the advertising material. The Customer will be granted one change during the advertising period at no extra cost. Should the Customer require any changes or alterations to the advertising thereafter, the Customer will be charged an administration fee of R150.

7. In consideration of its advertising services, the Customer agrees to pay the advertising fees set forth on the fee schedule as provided by the Advertising Service Provider. The advertising fee shall be a once off fee and shall be paid annually.

8. The Advertising Service Provider agrees to provide the advertising formats and the pricing as described in the schedule provided by The Advertising Service Provider

9. The Advertising Service Provider will use its reasonable efforts to make its Advertising Site available for display through the World Wide Web.

10. The duration of the advertising term will occur over the period of twelve months, after which the Customer can choose to renew the contract for an additional twelve months at a revised fee set by the Advertising Service Provider.

(Please tick the checkbox)(required)