Welcome Synergy members! Fill out the application below to receive full access to Dental Success Network. Step 1 of 4 25% 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. 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Dental License Number*AGD Number*If you do not have an AGD Number, enter 0Annual Revenue*Please SelectLess than $1,000,000$1,000,000 - $2,000,000$2,000,000 - $3,000,000$3,000,000 - $4,000,000$4,000,000 - $5,000,000$5,000,000 - $6,000,000$6,000,000 - $7,000,000$7,000,000 plusGST/HST NumberIf your practice is registered for GST/HST with the Canada Revenue Agency, please enter your GST/HST number. Leave blank if not applicable. Shirt Size*Extra SmallSmallMediumLargeExtra LargeDSN 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 Click here to view the DSN terms and conditions.Terms and Conditions* I agree to the DSN terms and conditions. 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.If you were referred to DSN by an existing member, enter their first and last name here:
