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New Member Registration

Are you a clinician or a vendor who wants to join the consortium? Simply fill out this form and once we verify your credentials, you'll have access to some great member benefits

Username
This is the login name you wish to have.
E-mail
You'll receive an e-mail asking you to confirm your addition to our member mailing list which will have a link so you can update your mail preferences.
Clinician
Tell us if you are a Clinician or a Vendor.
Credentials
Clinicians, please enter your credentials (MD, PA-C, CNP, etc). This is required to gain access to the clinical forum.
License Number
Clinicians, please enter your license number. This is required to gain access to the clinical forum.
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