Join CPRO | Clinic Procure

1

Clinic Information

Please provide the clinic's legal and operating information so CPRO can identify the correct organization and membership location in our records.

Legal Clinic / Practice Name *

Clinic / Practice Trade Name

Clinic / Practice Address *

City *

Province or Territory *

Postal Code *

2

Clinic Surgeons or Owners

Please provide the names of the surgeons or clinic owners associated with this location. Add additional rows as required.

The first person listed will be treated as the Main Surgeon / Owner and primary membership signatory. Their email address is required. Email addresses for additional surgeons or owners are optional.

First Name *

Last Name *

Email Address *

Primary membership and signatory email.

3

CPROmart^™ Authorized Purchasers

Please provide at least one person authorized to place orders on behalf of the clinic through CPROmart^™. The first authorized purchaser is required; add additional authorized purchasers as needed.

Authorized Purchaser 1

Required

First Name *

Last Name *

Email Address *

This is the email you will use to sign in to CPROmart^™.

Phone Number *

Purchasing Role *

I confirm that this person is authorized to place orders on behalf of the clinic / practice through CPROmart^™.

4

Terms and Conditions

Please review the CPRO Membership Terms and Conditions that govern your clinic's participation. Acceptance is required so CPRO can record the exact terms agreed to with this membership request.

Loading Terms and Conditions…

By checking this box and entering your initials below, you confirm that you have read and reviewed the CPRO Membership Terms and Conditions shown above.

Your Initials *

Confirm that you have read the Terms and Conditions to continue.

Clinic Information

Clinic Surgeons or Owners

CPROmart™ Authorized Purchasers

Terms and Conditions

CPROmart^™ Authorized Purchasers