Professional Solutions: Account Registration Form

Account Registration Form

Please fill out this form in order to gain access to special features of the Professional Solutions Web site. Once you click "Submit Registration", you will be asked to send in (via snail mail or fax) your accredation. All the details will be emailed to you.

Salutation
* User Name
* Password	Password must be between 6 and 20 characters
* Password Again	Re-enter password for verification
* Last Name
* First Name
Middle Initial
Practice/Business Name
* Practitioner Type	Other (please describe):
Specialty Type	Other (please describe):
* Street Address 1
* Street Address 2
* City
* State/Province	/
* Zip Code	-
* Country
* Phone Number	( ) - ext.
Fax Number	( ) -
* E-Mail address privacy policy	example: email@example.com
Web Address	example: www.example.com
* Would you like to receive emails regarding new research, published articles, new products, or conferences/lectures?	An email confirmation will be sent to you once your application has been approved.
* Do you regularly attend or plan to attend conferences?	Yes No
If you do attend conferences, please list them here:
* Do you currently sell any products?	Yes No
* Do you sell herbal products?	Yes No
* Do you currently sell Gaia Herbs products?	Yes No
* Do you currently compound herbal formulas?	Yes No
* Do you currently prescribe liquid extracts or capsules to patients?
* School Attended?
Terms of Service:	Gaia Herbs, Inc. (“Gaia”) provides through this Internet web site (the “Site”) limited access to qualified physicians to Gaia’s Online Practitioner Information System (the “Program”). These are the terms and conditions (the “Terms”) on which Gaia is willing to provide you access to the Program. If you do not agree to be bound by these Terms, do not click the “I Agree to Terms, Submit Application” button at the end of the registration page. 1. REGISTRATION AND ACCESS. You must register before you may access the Program. The information that you provide to Gaia in the registration process, including a valid physical address, email address, and appropriate licensing information, must be complete and accurate. You must update all registration information whenever necessary to keep it complete and accurate. When you register, you will select a username and password to which will allow you to access the Program. You are responsible for maintaining the confidentiality of your account number and password, for restricting access to your computer and for all activities that occur on your account. You may not assign your account to another person or company. Only individuals who can form legally binding contracts under applicable law may access the Program. Gaia reserves the right to limit or suspend access to the Program for any user who uses the Program in an inappropriate manner or in breach of these Terms. Gaia reserves the right, in its sole discretion, to suspend or terminate accounts and access to the Program. You may not download (other than page caching), modify, copy or exploit for commercial purposes any part of the Site or the Program. (This last sentence may not be appropriate since you will make a download of the catalogue, potentially the Protocol Manual, etc. available for download for commercial purposes.) 2. INFORMATION. a. You may only access the Program if you disclose certain personally identifiable information including your name, address, telephone number and email address. Therefore, if you do not wish to volunteer your personal information, do not register for the Program. By entering this personal information, you grant Gaia permission to contact you about selected products, companies and events we think may interest you via mail. During the registration process you can select whether or not you wish to receive email from Gaia regarding selected products, companies and events we think may interest you. If you later decide you do not want to be contacted via email, please log you’re your account and change your email preference. If you have any problems making this change or have questions regarding this please email registration@gaiaprofessional.com. Gaia may disclose your personal information if required to do so by law or to protect Gaia or any person or property. Gaia will not knowingly sell your personal information to any company that is not an affiliate of Gaia. b. Gaia uses data security systems and procedures to protect the privacy of personal information you provide to us. However, no security system is perfect, and Gaia cannot guarantee that personal information you provide to Gaia will remain private. We also cannot guarantee that information you transmit to Gaia over the Internet will not be intercepted. c. Gaia does not want you to send, and you should not send, any confidential or proprietary information to Gaia via this Site. You agree that any information or materials that you or individuals acting on your behalf provide to Gaia will not be considered confidential or proprietary. By providing any information or materials to Gaia, you grant to Gaia an unrestricted, perpetual, irrevocable, worldwide, royalty-free license to use, reproduce, display, publicly perform, exploit, transfer, transmit and distribute the information and materials. 3. OTHER SITES. This Site may make reference to names, marks, products or services of third parties or hyper text links to other web sites that may be of interest to you. These web sites have their own privacy, security, and terms of use statements. Gaia does not endorse any third parties or their products, services or web sites and is not responsible for the policies or content of any linked sites. If you decide to visit any third party web sites referenced on this Site or any linked site, you do so at your own risk. 4. COPYRIGHTS AND TRADEMARKS. All content, trademarks, service marks, information, designs, text, images, graphics and sounds on the Site and in the Program are the exclusive property of Gaia and its licensors. You may not make any other use of materials on the Site without the prior written permission of Gaia in each instance. You may not "frame" or "mirror" any content or information on, or accessible from, this Site without the prior written authorization of Gaia in each instance. 5. ERRORS. Gaia reserves the right to correct any inaccuracies or typographical errors in the Site or the Program. 6. DISCLAIMER OF WARRANTIES. GAIA IS PROVIDING THIS SITE AND THE PROGRAM ON AN "AS IS" AND "AS AVAILABLE" BASIS AND DISCLAIMS ALL REPRESENTATIONS AND WARRANTIES OF ANY KIND, EXPRESS OR IMPLIED, WITH RESPECT TO THIS SITE OR THE PROGRAM, INCLUDING THE IMPLIED WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE AND NON-INFRINGEMENT. 7. LIMITATION OF LIABILITY. GAIA SHALL NOT BE LIABLE TO YOU OR ANY THIRD PARTY FOR ANY DAMAGES ARISING OUT OF OR RELATING TO YOUR USE OF THIS SITE OR THE PROGRAM. IN NO EVENT SHALL GAIA BE LIABLE TO YOU OR ANY THIRD PARTY FOR ANY INDIRECT, EXEMPLARY, PUNITIVE, SPECIAL, INCIDENTAL, OR CONSEQUENTIAL DAMAGES, INCLUDING LOST REVENUE, PROFITS OR USE, ARISING FROM A BREACH OF CONTRACT, TORT OR OTHERWISE, EVEN IF GAIA HAS BEEN ADVISED OF THE POSSIBILITY OF THOSE DAMAGES. 8. MISCELLANEOUS. These Terms and any controversy relating to these Terms shall be governed by the laws of the State of North Carolina, United States of America, excluding its conflicts of law principles. Any action or proceeding relating to these Terms or their enforcement shall be commenced and heard only in the federal or state courts for the State of North Carolina. You and Gaia hereby consent and submit to the jurisdiction and venue of those courts. These Terms contain the entire agreement of the parties relating to the subject matter and supersede all previous and contemporaneous agreements, understandings, usages of trade and courses of dealing, whether written or oral. Gaia may modify these Terms at any time. You should visit this Site periodically to determine the current Terms that apply. Otherwise, these terms may only be modified by a written agreement signed by you and Gaia.
Once you click "Submit Registration", you will be asked to send in (via snail mail or fax) your accredation. All the details will be emailed to you.