Practitioner Application.

*Active is defined as healthcare professionals who are currently seeing patients and clients and who are caring for their personal health needs. In the event of the qualifying professional’s retirement, all purchase rights and benefits of the rebate programs will continue. In the event of the death of the qualifying professional, all purchase rights and benefits of the rebate programs will transfer to the named beneficiary as listed on this application. In the event of bankruptcy or insolvency of the qualifying health care professional, all purchase rights and benefits from rebate programs will immediately terminate. **State laws may vary. Void if not legal in your state.