To register online, fill out the form below; or print, sign and mail the form to Emulate Products.com

Application for the CUSTOMER AFFILIATE NETWORK (CAN) PROGRAM

P.O. Box 744, Donnelly, ID 83615 • 208-854-1067 • www .emulateproducts.com • info@emulateproducts.com

Please complete and submit this application. The application will be reviewed and we will be in contact with you in approximately 1 week to confirm your membership. When you receive your confirmation, you will be asked to pay a $60 registration fee upon submitting this application.If you are a member of the Emulate Green Club or Distributor programs, the $60 registration fee will be waived.With acceptance into the CAN Program, you agree to the terms and conditions of the CAN Program Agreement. Thank you for your interest and support of Emulate Natural Care. We look forward to serving you!

APPLICATION
First Name:*
Last Name:*
Preferred Username:
Address:*
E-mail:*
Birth Date (optional):
 / 
 / 
Telephone:*
-
Mobile Phone:
-
If you are a health professional please state your speciality:
Business name (if applicable):
Type of business:
Name of referring Emulate CAN Program member (if applicable):
I am currently registered as:

Terms and Conditions

(click here for a copy of the CAN Program Agreement)
By entering my initials in the box as my signature, I agree to the Terms and Conditions of Emulate Natural Care's Customer Affiliate Network (CAN) Program:*

All information will be kept confidential. At no time is any information sold for solicitation outside of Emulate Natural Care.

If you have any questions during our review period, please feel free to contact me. I will be glad
to assist you.

Suzanne Erdelt
CAN Program Manager
email: CANSupport@emulateproducts.com
775-225-2126

Captcha Verification - Please enter the word/number sequence exactly as it is displayed below:

When you are ready, click the button below to submit your application. You will be redirected to a page where you can add the $60 registration fee to your shopping cart and pay via Pay Pal or by phone.