For the following information, please provide your name, the email address we can use to send surveys and prototype inquiries to, as well as the phone number of your practice so we can find the shipping address associated with your account for prototype trials. 
 
Name*
 
 
Office Phone Number*
 
 
 
Email*
 
 
Country:*
 
 
 
 
Non-disclosure Agreement:

Garrison Dental Solutions (Discloser) is working on materials for use in the dental industry. The Receiver (undersigned below) has agreed to review these materials for the purpose of evaluation. The Receiver agrees to review the materials in confidence and agrees not to use the materials for any purpose without the prior express written consent of the Discloser. The Receiver will not disclose to others the fact that the Receiver is evaluating the materials. The Receiver agrees that only employees with a “need to know” will receive information regarding the materials and that these employees are bound by the terms of this agreement. The Receiver agrees to return the materials if the Discloser requests.

By signing below, you agree to these terms.

  
Digital Signature:*
 
 
Date:*
 
 
 
 

Garrison Product Advisory Group members must be full-time actively practicing dentists and Garrison customers.  We reserve the right to decline admission to the group and/or remove a participant from the group at our discretion.  If you are employed or otherwise engaged in any capacity by any company producing products that are in competition with Garrison products, please do not register for this group.