First Name*

Last Name*

Are you a Licensed or Certified Practitioner?*

Yes

No

Type of Practitioner and # of Years of Practice*

How many patients are you currently seeing (on average)? How frequently do you meet with your current patients (on average)?*

Please upload your license/certification

Please tell us about your accounts (Website URL, Social Handles, etc). Where will you be sharing ARMRA? (Website, Social, In-Person)?*

Instagram Profile (optional)

@

Country/region*

Address*

Apartment/Suite etc. (optional)

City*

State/Province Code (optional)

Zip code*

Do you live in the United States?*

Yes

No

Email Address (for communications to be sent to)*

Lumanu Email Address (for payment)*

Have you tried ARMRA Colostrum™ before? How did you hear about ARMRA?*

Why do you want to join The ARMRA Practitioner Program?*

For your patients' first ARMRA subscription order, we have the following commission and discount tiers. Select your preference. (Please note: For your patients' recurring subscription orders, you'll receive 5% commission and they will receive a 5% discount.)*

35% commission earned; 0% patient discount

30% commission earned; 5% patient discount

25% commission earned; 10% patient discount

20% commission earned; 15% patient discount

15% commission earned; 20% patient discount

10% commission earned; 25% patient discount

5% commission earned; 30% patient discount

0% commission earned; 35% patient discount

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