Please indicate how much experience you have in your chosen field.
Please select the area(s) of the dental industry that you are currently involved in.
Please tell us what professional organizations that you are a member of.
Please tell us about what social media platforms you use professionally to attract/share with your customers about your services? Please select all that apply.
Plesae tell us how you plan to use the service, and how Denali Group can assist in those goals.
We offer two affiliate options. You may choose 20% of net collections on unique link use or a 20% discount for all of your clients. Selection of discount option will require unique coupon code. That will be provided on approval of application.
PEASE REVIEW THE ITEMS BELOW CARFULLY. IF YOU ARE IN AGREEMENT PLEASE CLICK THE BOX NEXT TO THE ITEM. FAILURE TO CHECK ANY BOX WILL PREVENT DENALI GROUP FROM APPROVING THE APPLICATION. PLEASE NOTE THAT THIS WILL BE BINDING IF YOUR APPLICATION IS APPROVED.
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Drop files here or
Please upload completed and signed W-9 with your application. (You can email separately to firstname.lastname@example.org if you need to).