Initial Application - Educational Partner

We are thrilled to have you as a new Kidney Academy Educational Partner*!

Educational Partner Process:

Please complete the form below.
Once the form is received, we will contact your accounting person within 24-28 hours to collect billing information. No payment is required at this time.
Once payment has been received, we will contact your marketing person for the company logo and explain steps to get started.

*Educational Partner agreement last one year.

Company Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Accounting Contact's First & Last Name

Accounting Contact's Email Address

Accounting Contact's Phone Number

Marketing Contact's First & Last Name

Marketing Contact's Email Address

Marketing Contact's Phone Number