http://www.emerginginitiatives/Back Office Services - Business Memberships/advocacy for cures

Business Membership Application Form.

For Businesses & Institutions including Professional Services & Organizations etc.

Certain membership restrictions apply.

This form is reserved for US companies. If your company is located outside of USA please contact coordinator@emerginginitiatives.com

The individual submitting this form must be an authorized representative of business/institution etc.

Platinum.

Gold.

Silver.

Institutions.

Professional

Non-Profit.

Membership fees are payable in USD.

Annual membership fees: Platinum $ 500. Gold $ 300. Silver $ 200.

Institutions $ 100. Professionals/Others $ 50. Non-Profits $ 25.

First name

Last name

Company Name

Company Email

Company Address:

Address Line 2

Street Name

State

Zipcode:

Country:

Check Number:

Amount:

Date

I am 18 years old or above. (required)

I am an authorized representative. (required)

I understand "Emerging New Horizons Inc" dba Emerging Initiatives (emerginginitiatives.com) is an Advocacy Initiative and does NOT offer or provide any type of medical treatments/medications & cures or healthcare services and does not perform Research & Development (R &D) work.

I understand and agree to the above statement.

Do not enter anything in this field:

* indicates a required field

Please fill this field.

Questions? or for more information, please contact coordinator@emerginginitiatives.com

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