Partner Signup

Fields with an asterisk (*) are mandatory.

General

First Name *

Field is required

Last Name *

Field is required

Email *

Field is required

Email Confirmation *

Field is required

Phone Number

Company

Legal Entity Type *

Field is required

Please put in your full name or company name. *

Field is required

Website/Social Media

http(s)://

Address

Address 1 *

Field is required

Apartment, Suite, etc.

City *

Field is required

Postal Code *

Field is required

Country *

Field is required

Billing

Payment Method *

Field is required

PayPal Email Address

PayPal Email *

Field is required

Audience Information

What is your niche market? *

Field is required

Who is your audience? *

Health coaches, practitioners, and professionals

Naturopaths, massage therapists, acupuncture, etc.

Chiropractors

Licensed Medical (DO, Nurse practitioners, Nurses, etc.)

Educators

Health enthusiasts looking to help themselves and maybe others

Field is required

What is your email list size? All are welcome *

Field is required

What is your IG handle? *

Field is required

What's your IG following? *

Field is required

Do you sell B2B or B2C? *

B2B - Business to Business

B2C - Business to Consumer

Field is required

What do you sell/offer? *

Field is required

Are you a nurse? *

Yes

Field is required