Hemp Healthy Practitioner Affiliate Program Application
Please fill out this form to become a Hemp Healthy Practitioner Affiliate. Note that all fields are required, if the fields do not apply to you, simply add "N/A".
Email address *
Your Full Name *
Business/Individual Name *
Business Type *
Business Address (note: if approved we will be sending you custom marketing materials to the address listed). For multiple locations please list the address for each location. *
Medical Specialty *
Website *
On average, how many patients do you treat each month? *
How did you find out about Hemp Healthy?
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I have read and comply with the affiliate agreement: *
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