CDAPP Sweet Success Annual Affiliate Survey Due January 31, 2018

1.Please list the Primary CDAPP Sweet Success Affiliate site name that you are completing this Site Survey for.(Required.)

Affiliate Name

Primary CDAPP Sweet Success Affiliate Name:

If your primary affiliate site is not listed above or it is incorrectly displayed, please type the full name below:

2.Have you been a CDAPP Sweet Success Affiliate in the past?

Yes

No

3.Are you completing the survey for more than one (1) site?(Required.)

Yes

No

4.Affiliate Medical Director Name:(Required.)

5.Affiliate Address:(Required.)

Street Adress + Suite, Building, or Room Number

City

Zip Code

6.Please view your Affiliate Site(s) on our Affiliate Locator Online and tell us if you would like anything altered or added (e.g. phone number, website added, address change). Answer only the fields that apply and disregard this question if you are a new Affiliate.

Change my Affiliate or Satellite Name to:

Change my Phone Number to:

Change my Affiliate Address to:

Add an Email:

Add a Website:

Other (please type additional comments):

CDAPP Sweet Success Annual Affiliate Survey Due January 31, 2018

Part 1 (of 3): Affiliate or Satellite General Information

CDAPP Sweet Success Annual Affiliate Survey
Due January 31, 2018