Affiliate Manual Application (Mango Voice) - Dental Success Network

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About Us
- Leadership & Coaches
- Our Team
Upcoming Events
Contact Us
Log In

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Name*
First Last
Preferred DSN Email Address*
(Your Future Login if Accepted)*
Cell Phone Number*
Please provide the best cell number to receive the most up-to-date news and announcements. We will never spam you or share your info with anyone.

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*

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
This field is hidden when viewing the form
If you were referred to DSN by an existing member, enter their first and last name here:

DSN Membership
Consent*
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
support@dentalsuccessnetwork.com
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 support@dentalsuccessnetwork.com
I agree to the Cancellation/Refund Policy.
Click here to view the DSN terms and conditions.
Terms and Conditions
- I agree to the DSN terms and conditions.

Finally you understand that, if accepted, there is a monthly membership fee of $239 per month starting at the time of sign up.
Finally you understand that, if accepted, there is a monthly membership fee of $199 per month starting at the time of sign up.*
- Yes
Credit Card
Card Details
Cardholder Name

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(928) 968-3505

EMAIL

support@dentalsuccessnetwork.com

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