The Body Healthcare - Membership Checkout

Membership Information

You have selected the BUSINESS MEMBER - 1 Year membership level.

Business Membership For One Year, Auto Renew Membership After One Year @ $105.00

The price for membership is $105.00 now.

Membership expires after 1 Year.

Do you have a discount code?

Account Information

Username

Password

Confirm Password

Hint: The password should be at least twelve characters long. To make it stronger, use upper and lower case letters, numbers, and symbols like ! " ? $ % ^ & ).

First Name

Last Name

Email Address

Confirm Email Address

Full Name LEAVE THIS BLANK

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Personal Details

Date Of Birth

Phone Number

Make sure you put a number here as its used on profile page

Address 1

Address 2

City

Province/State

Postal Code/Zip Code

Country

Home Phone Number

Cell Phone Number

Provider-Facility Name

Name Of Your Provider Or Facility You Attend

Business Information

Your Business Name

Business Phone Number

Business Fax Number

Business Website Address

Example - www.mywebsite.com

Business Email Address

Business TIN/EIN

Business Address

Enter your business full address above

Services Offered

Clincial: List the clinical services you intend to offer to members.
Other Business: List the services that your business offers.

Specialties

Here you will list any specialty services you may offer members

Add your specialty services you provide

enter one specialty per line please

Main Specialty You Offer

Please enter one short phrase or word for the main specialty you offer, example: acupuncture. This will be shown on your profile page and our members dirtectory

Agreement The Body Membership Agreement

The Body Membership Agreement Form must be thoroughly reviewed and accepted prior to submitting your Members Form, along with your electronic signature for our disclosure.

The Body Membership Agreement

Please click link to open document and read this Agreement. By clicking in the checkbox, you agree to everything on the Body Membership Agreement

Agreement The Body Arbitration

The Body Arbitration Form must be thoroughly reviewed and accepted prior to submitting your Members Form, along with your electronic signature for our disclosure.

The Body Arbitration

Please click link to open document and read this Agreement. By clicking in the checkbox, you agree to everything on the The Body Arbitration

By Electronically Signing This Form Below

You confirm that you have read the "Body Membership Agreement" and "The Body Arbitration" forms provided above. Additionally, you consent to being added to our email list, allowing us to contact you concerning your membership and to send you our newsletters.

Your Full Name

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