http://www.emerginginitiatives/Back Office Services

FORM: FREE Membership for patients/family/friends and care givers.

No Medical questions to answer & no phone number or email required. No commitments of any type. Short & easy form to fill.

POSTAL address is required to process your membership application.

First name

Last name

Email (optional)

Postal Address:

Address line 2

Street:

City:

State

Zipcode

Country:

I am a patient/family member/friend/care-giver. (required)

Free membership. (required)

I am 18 years old and/or above. (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.

I understand & agree to the above statement. (required)

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