DSN Membership Application - Road Map Series

Step 1 of 5

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Name*

First Last

Preferred DSN Email Address*

(Your Future Login if Accepted)*

Password*

Enter Password Confirm Password

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Cell Phone Number*

Consent*

By providing your number, checking this box, and clicking “Submit” at the end of the application, you consent to receive recurring automated promotional and marketing messages from Dental Success Network and agree to our Terms of Use and Privacy Policy. Message HELP for help, STOP to cancel. Consent is not a condition of any purchase. Msg & data rates may apply.

Shipping Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Clinic Name*

Simply part of the vetting process (even if not an owner, we want to learn about where you work)

How many clinics are you an owner in, if any?*

If an Associate, enter 0.

Dental License Number*

AGD Number*

If you do not have an AGD Number, enter 0

Annual Revenue*

Shirt Size

DSN provides our partners with a list of our members and contact information so you don’t miss a beat in savings with suppliers you may already be using!*

We understand and value our member’s privacy. If sharing your office information with our partners is something you would like to opt-out of, we get it! Simply click “Do not share my information”.

Yes, share my information with DSN vendors

No, do not share my information with DSN vendors

What part of the Dental Success Network are you most interested in?*

Savings & Vendor Discounts

Team Training

Continued Education

Startup & Acquisition

Growing My Practice

What three challenges can we help you solve?*

*Please Select Three

Systemization Implementation

Team Culture

Become a Better Leader

Understanding Cash Flow

Inventory & Overhead Control

Understanding My Business

DSN Membership

Terms and Conditions

Dental Success Network Terms and Conditions apply for every member using interactive areas of this site and
agrees to adhere to. These terms are in addition to the Privacy Policy and Terms of Use for the Website. By
accessing the member space at DentalSuccessNetwork.com and the DSN Workplace powered by Meta, you
agree to abide by these terms and the Terms of Use of the Website.

I agree to the DSN terms and conditions.

Cancellation/Refund Policy*

CANCELLATION POLICY: Members can cancel at ANYTIME. All cancellation requests must be submitted through the “Contact Us” form located anywhere on the site. All cancellation requests submitted 24 hours prior to invoice due date will be charged. However, Dental Success Network will refund the total invoice amount. Any cancellation request submitted over the weekend will be reviewed and processed the next business day. For questions regarding DSN’s cancellation policy please contact
[email protected]
REFUND POLICY: All refunds are processed at DSN discretion excluding members who request to cancel membership within 24 hours of invoice due date. Members who have requested to cancel their membership within 24 hours of the invoice due date can expect a full refund. Refunds will not be processed to non-usage of the network.
For questions regarding DSN’s cancellation policy please contact [email protected]

I agree to the Cancellation/Refund Policy.

How did you hear about DSN?*

Enter the member's first and last name here:*

Other:*

Finally you understand that, if accepted, there is a monthly membership fee of $239 per month starting at the time of sign up.*

This is a NO CONTRACT, CANCEL ANYTIME approach because we want you in Position #1…finally.
Why pay? Because communities that pay, pay attention. AND if you don’t pay, then YOU ARE THE PRODUCT.
We have a high quality group of members and faculty that focus on you, and all of our efforts are here to serve your needs!

Yes

Credit Card*

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DSN Membership Application – Road Map Series

DSN Membership Application (Road Map Series)

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