Registration User Email * First Name Last Name Clinic/Dispensary Name Is the account to be opened in the clinic/dispensary name? No Yes Address 1 Address 2 Town / City State / County / Region Postcode / Zip Phone What kind of practitioner/student are you? AcupuncturistAcupuncture StudentTCM PractitionerTCM StudentNaturopathic DoctorNaturopathic StudentPhysiotherapistPhysiotherapy StudentMassage TherapistMassage Therapy StudentVeterinarianVeterinarian StudentMedical DoctorMedical StudentHerbalistHerbalist StudentNutritionistNutrition StudentChiropractorChiropractor Student Choose from the dropdown list License Number Please enter the license number applicable to your profession. This number is required to access certain products and wholesale pricing. If you are a student, indicate STUDENT in this field Student Number Please enter your student. This number is required to access certain products and wholesale pricing. If you are a practitioner, indicate PRACTITIONER in this field What School did/do you attend? What year did/will you graduate? Check all the boxes of the modalities you use in your practice/clinic Acupuncture Herbs (you will need to complete the herbal reseller agreement before being granted access to herbs) Whole Food supplements Lasers Cupping Moxa Massage Essential Oils Continuing Education Electro-stimulation Auricular therapy Hand Therapy Other (please list below) Other modalities used not list above Submit