{"id":12425,"date":"2025-05-02T13:59:43","date_gmt":"2025-05-02T19:59:43","guid":{"rendered":"https:\/\/radiologyassist.com\/StagingAvada\/?page_id=12425"},"modified":"2025-05-02T14:23:43","modified_gmt":"2025-05-02T20:23:43","slug":"affiliate-program-start","status":"publish","type":"page","link":"https:\/\/radiologyassist.com\/StagingAvada\/become-an-affiliate\/affiliate-program-start\/","title":{"rendered":"Become an affiliate"},"content":{"rendered":"<div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1 fusion-flex-container has-pattern-background has-mask-background fusion-parallax-none nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-min-height:271px;--awb-background-image:url(&quot;https:\/\/radiologyassist.com\/StagingAvada\/wp-content\/uploads\/2025\/04\/BG_Footer.png&quot;);--awb-background-size:cover;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"max-width:1331.2px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-0 fusion_builder_column_1_1 1_1 fusion-flex-column fusion-flex-align-self-center\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-title title fusion-title-1 fusion-sep-none fusion-title-text fusion-title-size-one\" style=\"--awb-text-color:#ffffff;--awb-font-size:30px;\"><h1 class=\"fusion-title-heading title-heading-left\" style=\"font-family:&quot;Open Sans&quot;;font-style:normal;font-weight:700;margin:0;font-size:1em;line-height:20px;\">Become an affiliate<\/h1><\/div><\/div><\/div><\/div><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-2 fusion-flex-container has-pattern-background has-mask-background nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-padding-top:30px;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"max-width:1331.2px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-1 fusion_builder_column_2_3 2_3 fusion-flex-column gravity-upload-referral-form\" style=\"--awb-bg-size:cover;--awb-width-large:66.666666666667%;--awb-margin-top-large:0px;--awb-spacing-right-large:2.88%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:2.88%;--awb-width-medium:60%;--awb-order-medium:0;--awb-spacing-right-medium:3.2%;--awb-spacing-left-medium:3.2%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\" data-scroll-devices=\"small-visibility,medium-visibility,large-visibility\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-text fusion-text-1\" style=\"--awb-content-alignment:left;--awb-font-size:18px;--awb-line-height:24px;--awb-text-color:#520a1c;--awb-text-font-family:&quot;Open Sans&quot;;--awb-text-font-style:normal;--awb-text-font-weight:400;\">\n                <div class='gf_browser_gecko gform_wrapper' id='gform_wrapper_49' style='display:none'><div id='gf_49' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_49' id='gform_49'  action='\/StagingAvada\/wp-json\/wp\/v2\/pages\/12425#gf_49'>\n        <div id='gf_progressbar_wrapper_49' class='gf_progressbar_wrapper'>\n            <h3 class='gf_progressbar_title'>Step 1 of 4\n        <\/h3>\n            <div class='gf_progressbar' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blue percentbar_25' style='width:25%;'><span>25%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform_body'><div id='gform_page_49_1' class='gform_page' >\n                                    <div class='gform_page_fields'><ul id='gform_fields_49' class='gform_fields top_label form_sublabel_above description_above'><li id='field_49_8'  class='gfield gsection field_sublabel_above field_description_above gfield_visibility_visible' ><h2 class='gsection_title'>Your Personal Information<\/h2><\/li><li id='field_49_1'  class='gfield gfield_contains_required field_sublabel_above field_description_above gfield_visibility_visible' ><label class='gfield_label gfield_label_before_complex'  >Payee Name<span class='gfield_required'>*<\/span><\/label><div class='gfield_description' id='gfield_description_49_1'>Enter the name exactly as it should appear on the check. If the check is to be mailed to an individual other than the Payee, enter the name of the recipient in \"Address 1\" below<\/div><div class='ginput_complex ginput_container no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name' id='input_49_1'>\n                            \n                            <span id='input_49_1_3_container' class='name_first' >\n                                                    <label for='input_49_1_3' >First<\/label>\n                                                    <input type='text' name='input_1.3' id='input_49_1_3' value='' aria-label='First name'   aria-required=\"true\" aria-invalid=\"false\" \/>\n                                                <\/span>\n                            \n                            <span id='input_49_1_6_container' class='name_last' >\n                                                            <label for='input_49_1_6' >Last<\/label>\n                                                            <input type='text' name='input_1.6' id='input_49_1_6' value='' aria-label='Last name'   aria-required=\"true\" aria-invalid=\"false\" \/>\n                                                        <\/span>\n                            \n                        <\/div><\/li><li id='field_49_26'  class='gfield gfield_contains_required field_sublabel_above field_description_above gfield_visibility_visible' ><label class='gfield_label' for='input_49_26' >Phone<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_26' id='input_49_26' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/li><li id='field_49_2'  class='gfield gfield_contains_required field_sublabel_above field_description_above gfield_visibility_visible' ><label class='gfield_label gfield_label_before_complex'  >Your Email Address<span class='gfield_required'>*<\/span><\/label><div class='ginput_complex ginput_container ginput_container_email' id='input_49_2_container'>\n                                <span id='input_49_2_1_container' class='ginput_left'>\n                                    <label for='input_49_2'>Enter Email<\/label>\n                                    <input class='' type='email' name='input_2' id='input_49_2' value=''    aria-required=\"true\" aria-invalid=\"false\"\/>\n                                <\/span>\n                                <span id='input_49_2_2_container' class='ginput_right'>\n                                    <label for='input_49_2_2' >Confirm Email<\/label>\n                                    <input class='' type='email' name='input_2_2' id='input_49_2_2' value=''    aria-required=\"true\" aria-invalid=\"false\"\/>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/li><li id='field_49_21'  class='gfield gfield_contains_required field_sublabel_above field_description_above gfield_visibility_visible' ><label class='gfield_label gfield_label_before_complex'  >Address<span class='gfield_required'>*<\/span><\/label>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address' id='input_49_21' >\n                         <span class='ginput_full address_line_1' id='input_49_21_1_container' >\n                                        <label for='input_49_21_1' id='input_49_21_1_label' >Street Address<\/label>\n                                        <input type='text' name='input_21.1' id='input_49_21_1' value=''    aria-required=\"true\"\/>\n                                    <\/span><span class='ginput_full address_line_2' id='input_49_21_2_container' >\n                                        <label for='input_49_21_2' id='input_49_21_2_label' >Address Line 2<\/label>\n                                        <input type='text' name='input_21.2' id='input_49_21_2' value=''   \/>\n                                    <\/span><span class='ginput_left address_city' id='input_49_21_3_container' >\n                                    <label for='input_49_21_3' id='input_49_21_3_label' >City<\/label>\n                                    <input type='text' name='input_21.3' id='input_49_21_3' value=''    aria-required=\"true\"\/>\n                                 <\/span><span class='ginput_right address_state' id='input_49_21_4_container' >\n                                        <label for='input_49_21_4' id='input_49_21_4_label' >State \/ Province \/ Region<\/label>\n                                        <input type='text' name='input_21.4' id='input_49_21_4' value=''      aria-required=\"true\"\/>\n                                      <\/span><span class='ginput_left address_zip' id='input_49_21_5_container' >\n                                    <label for='input_49_21_5' id='input_49_21_5_label' >ZIP \/ Postal Code<\/label>\n                                    <input type='text' name='input_21.5' id='input_49_21_5' value=''    aria-required=\"true\"\/>\n                                <\/span><span class='ginput_right address_country' id='input_49_21_6_container' >\n                                        <label for='input_49_21_6' id='input_49_21_6_label' >Country<\/label>\n                                        <select name='input_21.6' id='input_49_21_6'   aria-required=\"true\"><option value='' selected='selected'><\/option><option value='AF' >Afghanistan<\/option><option value='AL' >Albania<\/option><option value='DZ' >Algeria<\/option><option value='AS' >American Samoa<\/option><option value='AD' >Andorra<\/option><option value='AO' >Angola<\/option><option value='AI' >Anguilla<\/option><option value='AQ' >Antarctica<\/option><option value='AG' >Antigua and Barbuda<\/option><option value='AR' >Argentina<\/option><option value='AM' >Armenia<\/option><option value='AW' >Aruba<\/option><option value='AU' >Australia<\/option><option value='AT' >Austria<\/option><option value='AZ' >Azerbaijan<\/option><option value='BS' >Bahamas<\/option><option value='BH' >Bahrain<\/option><option value='BD' >Bangladesh<\/option><option value='BB' >Barbados<\/option><option value='BY' >Belarus<\/option><option value='BE' >Belgium<\/option><option value='BZ' >Belize<\/option><option value='BJ' >Benin<\/option><option value='BM' >Bermuda<\/option><option value='BT' >Bhutan<\/option><option value='BO' >Bolivia<\/option><option value='BQ' >Bonaire, Sint Eustatius and Saba<\/option><option value='BA' >Bosnia and Herzegovina<\/option><option value='BW' >Botswana<\/option><option value='BV' >Bouvet Island<\/option><option value='BR' >Brazil<\/option><option value='IO' >British Indian Ocean Territory<\/option><option value='BN' >Brunei Darussalam<\/option><option value='BG' >Bulgaria<\/option><option value='BF' >Burkina Faso<\/option><option value='BI' >Burundi<\/option><option value='KH' >Cambodia<\/option><option value='CM' >Cameroon<\/option><option value='CA' >Canada<\/option><option value='CV' >Cape Verde<\/option><option value='KY' >Cayman Islands<\/option><option value='CF' >Central African Republic<\/option><option value='TD' >Chad<\/option><option value='CL' >Chile<\/option><option value='CN' >China<\/option><option value='CX' >Christmas Island<\/option><option value='CC' >Cocos Islands<\/option><option value='CO' >Colombia<\/option><option value='KM' >Comoros<\/option><option value='CD' >Congo, Democratic Republic of the<\/option><option value='CG' >Congo, Republic of the<\/option><option value='CK' >Cook Islands<\/option><option value='CR' >Costa Rica<\/option><option value='HR' >Croatia<\/option><option value='CU' >Cuba<\/option><option value='CW' >Cura\u00e7ao<\/option><option value='CY' >Cyprus<\/option><option value='CZ' >Czech Republic<\/option><option value='CI' >C\u00f4te d&#039;Ivoire<\/option><option value='DK' >Denmark<\/option><option value='DJ' >Djibouti<\/option><option value='DM' >Dominica<\/option><option value='DO' >Dominican Republic<\/option><option value='EC' >Ecuador<\/option><option value='EG' >Egypt<\/option><option value='SV' >El Salvador<\/option><option value='GQ' >Equatorial Guinea<\/option><option value='ER' >Eritrea<\/option><option value='EE' >Estonia<\/option><option value='SZ' >Eswatini (Swaziland)<\/option><option value='ET' >Ethiopia<\/option><option value='FK' >Falkland Islands<\/option><option value='FO' >Faroe Islands<\/option><option value='FJ' >Fiji<\/option><option value='FI' >Finland<\/option><option value='FR' >France<\/option><option value='GF' >French Guiana<\/option><option value='PF' >French Polynesia<\/option><option value='TF' >French Southern Territories<\/option><option value='GA' >Gabon<\/option><option value='GM' >Gambia<\/option><option value='GE' >Georgia<\/option><option value='DE' >Germany<\/option><option value='GH' >Ghana<\/option><option value='GI' >Gibraltar<\/option><option value='GR' >Greece<\/option><option value='GL' >Greenland<\/option><option value='GD' >Grenada<\/option><option value='GP' >Guadeloupe<\/option><option value='GU' >Guam<\/option><option value='GT' >Guatemala<\/option><option value='GG' >Guernsey<\/option><option value='GN' >Guinea<\/option><option value='GW' >Guinea-Bissau<\/option><option value='GY' >Guyana<\/option><option value='HT' >Haiti<\/option><option value='HM' >Heard and McDonald Islands<\/option><option value='VA' >Holy See<\/option><option value='HN' >Honduras<\/option><option value='HK' >Hong Kong<\/option><option value='HU' >Hungary<\/option><option value='IS' >Iceland<\/option><option value='IN' >India<\/option><option value='ID' >Indonesia<\/option><option value='IR' >Iran<\/option><option value='IQ' >Iraq<\/option><option value='IE' >Ireland<\/option><option value='IM' >Isle of Man<\/option><option value='IL' >Israel<\/option><option value='IT' >Italy<\/option><option value='JM' >Jamaica<\/option><option value='JP' >Japan<\/option><option value='JE' >Jersey<\/option><option value='JO' >Jordan<\/option><option value='KZ' >Kazakhstan<\/option><option value='KE' >Kenya<\/option><option value='KI' >Kiribati<\/option><option value='KW' >Kuwait<\/option><option value='KG' >Kyrgyzstan<\/option><option value='LA' >Lao People&#039;s Democratic Republic<\/option><option value='LV' >Latvia<\/option><option value='LB' >Lebanon<\/option><option value='LS' >Lesotho<\/option><option value='LR' >Liberia<\/option><option value='LY' >Libya<\/option><option value='LI' >Liechtenstein<\/option><option value='LT' >Lithuania<\/option><option value='LU' >Luxembourg<\/option><option value='MO' >Macau<\/option><option value='MK' >Macedonia<\/option><option value='MG' >Madagascar<\/option><option value='MW' >Malawi<\/option><option value='MY' >Malaysia<\/option><option value='MV' >Maldives<\/option><option value='ML' >Mali<\/option><option value='MT' >Malta<\/option><option value='MH' >Marshall Islands<\/option><option value='MQ' >Martinique<\/option><option value='MR' >Mauritania<\/option><option value='MU' >Mauritius<\/option><option value='YT' >Mayotte<\/option><option value='MX' >Mexico<\/option><option value='FM' >Micronesia<\/option><option value='MD' >Moldova<\/option><option value='MC' >Monaco<\/option><option value='MN' >Mongolia<\/option><option value='ME' >Montenegro<\/option><option value='MS' >Montserrat<\/option><option value='MA' >Morocco<\/option><option value='MZ' >Mozambique<\/option><option value='MM' >Myanmar<\/option><option value='NA' >Namibia<\/option><option value='NR' >Nauru<\/option><option value='NP' >Nepal<\/option><option value='NL' >Netherlands<\/option><option value='NC' >New Caledonia<\/option><option value='NZ' >New Zealand<\/option><option value='NI' >Nicaragua<\/option><option value='NE' >Niger<\/option><option value='NG' >Nigeria<\/option><option value='NU' >Niue<\/option><option value='NF' >Norfolk Island<\/option><option value='KP' >North Korea<\/option><option value='MP' >Northern Mariana Islands<\/option><option value='NO' >Norway<\/option><option value='OM' >Oman<\/option><option value='PK' >Pakistan<\/option><option value='PW' >Palau<\/option><option value='PS' >Palestine, State of<\/option><option value='PA' >Panama<\/option><option value='PG' >Papua New Guinea<\/option><option value='PY' >Paraguay<\/option><option value='PE' >Peru<\/option><option value='PH' >Philippines<\/option><option value='PN' >Pitcairn<\/option><option value='PL' >Poland<\/option><option value='PT' >Portugal<\/option><option value='PR' >Puerto Rico<\/option><option value='QA' >Qatar<\/option><option value='RO' >Romania<\/option><option value='RU' >Russia<\/option><option value='RW' >Rwanda<\/option><option value='RE' >R\u00e9union<\/option><option value='BL' >Saint Barth\u00e9lemy<\/option><option value='SH' >Saint Helena<\/option><option value='KN' >Saint Kitts and Nevis<\/option><option value='LC' >Saint Lucia<\/option><option value='MF' >Saint Martin<\/option><option value='PM' >Saint Pierre and Miquelon<\/option><option value='VC' >Saint Vincent and the Grenadines<\/option><option value='WS' >Samoa<\/option><option value='SM' >San Marino<\/option><option value='ST' >Sao Tome and Principe<\/option><option value='SA' >Saudi Arabia<\/option><option value='SN' >Senegal<\/option><option value='RS' >Serbia<\/option><option value='SC' >Seychelles<\/option><option value='SL' >Sierra Leone<\/option><option value='SG' >Singapore<\/option><option value='SX' >Sint Maarten<\/option><option value='SK' >Slovakia<\/option><option value='SI' >Slovenia<\/option><option value='SB' >Solomon Islands<\/option><option value='SO' >Somalia<\/option><option value='ZA' >South Africa<\/option><option value='GS' >South Georgia<\/option><option value='KR' >South Korea<\/option><option value='SS' >South Sudan<\/option><option value='ES' >Spain<\/option><option value='LK' >Sri Lanka<\/option><option value='SD' >Sudan<\/option><option value='SR' >Suriname<\/option><option value='SJ' >Svalbard and Jan Mayen Islands<\/option><option value='SE' >Sweden<\/option><option value='CH' >Switzerland<\/option><option value='SY' >Syria<\/option><option value='TW' >Taiwan<\/option><option value='TJ' >Tajikistan<\/option><option value='TZ' >Tanzania<\/option><option value='TH' >Thailand<\/option><option value='TL' >Timor-Leste<\/option><option value='TG' >Togo<\/option><option value='TK' >Tokelau<\/option><option value='TO' >Tonga<\/option><option value='TT' >Trinidad and Tobago<\/option><option value='TN' >Tunisia<\/option><option value='TR' >Turkey<\/option><option value='TM' >Turkmenistan<\/option><option value='TC' >Turks and Caicos Islands<\/option><option value='TV' >Tuvalu<\/option><option value='UM' >US Minor Outlying Islands<\/option><option value='UG' >Uganda<\/option><option value='UA' >Ukraine<\/option><option value='AE' >United Arab Emirates<\/option><option value='GB' >United Kingdom<\/option><option value='US' >United States<\/option><option value='UY' >Uruguay<\/option><option value='UZ' >Uzbekistan<\/option><option value='VU' >Vanuatu<\/option><option value='VE' >Venezuela<\/option><option value='VN' >Vietnam<\/option><option value='VG' >Virgin Islands, British<\/option><option value='VI' >Virgin Islands, U.S.<\/option><option value='WF' >Wallis and Futuna<\/option><option value='EH' >Western Sahara<\/option><option value='YE' >Yemen<\/option><option value='ZM' >Zambia<\/option><option value='ZW' >Zimbabwe<\/option><option value='AX' >\u00c5land Islands<\/option><\/select>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id='field_49_28'  class='gfield gfield_contains_required field_sublabel_above field_description_above gfield_visibility_visible' ><label class='gfield_label'  >Who is the main contact for this account?<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_49_28'><li class='gchoice_49_28_0'><input name='input_28' type='radio' value='The payee listed above' checked='checked' id='choice_49_28_0'    \/><label for='choice_49_28_0' id='label_49_28_0'>The payee listed above<\/label><\/li><li class='gchoice_49_28_1'><input name='input_28' type='radio' value='Someone else - I need to enter their information'  id='choice_49_28_1'    \/><label for='choice_49_28_1' id='label_49_28_1'>Someone else - I need to enter their information<\/label><\/li><\/ul><\/div><\/li><li id='field_49_29'  class='gfield gfield_contains_required field_sublabel_above field_description_above gfield_visibility_visible' ><label class='gfield_label' for='input_49_29' >Contact Name<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_29' id='input_49_29' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\" \/><\/div><\/li><li id='field_49_10'  class='gfield gfield_contains_required field_sublabel_above field_description_above gfield_visibility_visible' ><label class='gfield_label' for='input_49_10' >Contact Phone Number<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_10' id='input_49_10' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer'>\n                         <input type='button' id='gform_next_button_49_18' class='gform_next_button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_49\").val(\"2\");  jQuery(\"#gform_49\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_49\").val(\"2\");  jQuery(\"#gform_49\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_49_2' class='gform_page' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_49_2' class='gform_fields top_label form_sublabel_above description_above'><li id='field_49_7'  class='gfield gsection field_sublabel_above field_description_above gfield_visibility_visible' ><h2 class='gsection_title'>Website and Mobile App List<\/h2><div class='gsection_description' id='gfield_description_49_7'>List all the top-level websites and \/or mobile apps on which you plan to display banners, widgets and other digital assets. You need to add at least one website or mobile app.<\/div><\/li><li id='field_49_30'  class='gfield field_sublabel_above field_description_above gfield_visibility_visible' ><label class='gfield_label' for='input_49_30' >Enter Your Website(s)<\/label><div class='ginput_container ginput_container_website'>\n                    <input name='input_30' id='input_49_30' type='url' value='' class='large'    placeholder='https:\/\/'  aria-invalid=\"false\"\/>\n                <\/div><\/li><li id='field_49_31'  class='gfield field_sublabel_above field_description_above gfield_visibility_visible' ><label class='gfield_label' for='input_49_31' >Enter Your Social Media URL(s)<\/label><div class='ginput_container ginput_container_website'>\n                    <input name='input_31' id='input_49_31' type='url' value='' class='large'    placeholder='https:\/\/'  aria-invalid=\"false\"\/>\n                <\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer'>\n                        <input type='button' id='gform_previous_button_49_20' class='gform_previous_button button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_49\").val(\"1\");  jQuery(\"#gform_49\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_49\").val(\"1\");  jQuery(\"#gform_49\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_49_20' class='gform_next_button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_49\").val(\"3\");  jQuery(\"#gform_49\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_49\").val(\"3\");  jQuery(\"#gform_49\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_49_3' class='gform_page' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_49_3' class='gform_fields top_label form_sublabel_above description_above'><li id='field_49_11'  class='gfield gsection field_sublabel_above field_description_above gfield_visibility_visible' ><h2 class='gsection_title'>Additional Information<\/h2><\/li><li id='field_49_32'  class='gfield gfield_contains_required field_sublabel_above field_description_above gfield_visibility_visible' ><label class='gfield_label' for='input_49_32' >What is your preferred Referral ID?<span class='gfield_required'>*<\/span><\/label><div class='gfield_description' id='gfield_description_49_32'> (This is an alphanumeric ID of your choosing, with no special characters or spaces.)<\/div><div class='ginput_container ginput_container_text'><input name='input_32' id='input_49_32' type='text' value='' class='large'  aria-describedby=\"gfield_description_49_32\"   aria-required=\"true\" aria-invalid=\"false\" \/><\/div><\/li><li id='field_49_12'  class='gfield gfield_contains_required field_sublabel_above field_description_above gfield_visibility_visible' ><label class='gfield_label' for='input_49_12' >Tell Us About Content you create<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_12' id='input_49_12' class='textarea medium'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id='field_49_33'  class='gfield gfield_contains_required field_sublabel_above field_description_above gfield_visibility_visible' ><label class='gfield_label' for='input_49_33' >How did you hear about us?<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_33' id='input_49_33' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\" \/><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer'>\n                        <input type='button' id='gform_previous_button_49_34' class='gform_previous_button button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_49\").val(\"2\"); 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and WHEREAS, the AFFILIATE agrees to provide such marketing services on the terms and conditions set forth herein.<\/p> <br>\n\n<h3>AGREEMENT:<\/h3> \n<p><b>Engagement: <\/b>The Company hereby engages the AFFILIATE, and the AFFILIATE hereby accepts such engagement, to act as an independent contractor to perform the services described herein.<\/p> <br>\n\n<p><b>Services:<\/b> The AFFILIATE agrees to create and share content related to the Company\u2019s products, including posts, stories, and videos on social media, websites, or blogs, as specified in this Agreement.<\/p> <br>\n\n<h3>COMPENSATION:<\/h3> \n<p>The AFFILIATE shall be entitled to commissions on all sales generated through their unique referral links or promo codes provided by the Company, as outlined in Exhibit A attached hereto and made a part hereof.<br> Commissions will be calculated based on the net sales amount, excluding taxes, shipping, and handling fees. Payments will be made on a Monthly basis, within 30 days of the end of each period. <br>\n\n<b>Commission Duration:<\/b> The commissions shall be paid to the AFFILIATE during the term of the Agreement. <br>\n\n<b>Terms and Termination:<\/b> This Agreement shall commence on the date hereof and shall continue and stay in effect until terminated by either party upon written notice. Company reserves the right to modify the compensation amount as well as discontinue or terminate the AFFILIATE agreement at any time.<br> \n\n<b>Healthcare Disclaimer:<\/b> The AFFILIATE acknowledges and agrees that they are not involved in the provision of healthcare services to any referred customers. The Influencer is not a referring physician or healthcare provider for any referred customers and will not gain from this agreement for patients under the care of the AFFILIATE. <br>\n\n<b>Independent Contractors:<\/b> In the performance of the duties and obligations imposed under this Agreement, it is mutually agreed that AFFILIATE at all times shall be, acting as an independent contractor engaged in the business of furnishing Services to AHG. AHG shall neither have nor exercise control or direction over the methods by which AFFILIATE shall perform their duties and obligations arising hereunder. This Agreement is not, and shall not be considered, an employer-employee relationship, joint venture or partnership of any kind, and neither party shall represent to any third persons that any such relationship exists. <br>\n\n<b>Representations and Warranties:<\/b> The AFFILIATE represents and warrants that they will comply with all applicable laws, regulations, and guidelines, including but not limited to FTC guidelines for endorsements and testimonials. The AFFILIATE warrants that the content created will be original and will not infringe on any third-party rights. <\/br>\n\n<b>Indemnification:<\/b> The AFFILIATE agrees to indemnify and hold harmless the Company from any claims, damages, losses, and expenses arising out of the AFFILIATE's breach of this Agreement or the AFFILIATE\u2019s negligence or misconduct.<\/br> \n\n<b>Confidentiality:<\/b> The AFFILIATE shall maintain in strict confidence all confidential information of the Company and shall not disclose such information to any third party. <\/br>\n\n<b>Governing Law:<\/b> This Agreement shall be governed by and construed in accordance with the laws of the State of Texas. Should either party employ an attorney for the purpose of enforcing this Agreement, or any judgment based hereon in any court, including bankruptcy court, courts of appeal or arbitration proceedings, each party shall be responsible for its attorneys' fees and costs.<br> \n\n<b>Defamation:<\/b> The AFFILIATE agrees not to make any statements or comments, whether orally or in writing, that could defame, disparage, or in any way criticize the Company, its products, services, business practices, directors, officers, agents, employees, or affiliates. The Influencer agrees to remove any such statements immediately upon the Company\u2019s request.<br>\n IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the date first above written.<\/p><\/li><li id='field_49_37'  class='gfield gfield_contains_required field_sublabel_above field_description_above gfield_visibility_visible' ><label class='gfield_label' for='input_49_37' >Date of Agreement<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_37' id='input_49_37' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\" \/><\/div><\/li><li id='field_49_38'  class='gfield gfield_contains_required field_sublabel_above field_description_above gfield_visibility_visible' ><label class='gfield_label' for='input_49_38' >Affiliate Signature<span class='gfield_required'>*<\/span><\/label><div ><div id='input_49_38_Container' class='gfield_signature_container ginput_container' style='height:180px; 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'1' : '');}); }} } );jQuery(document).bind('gform_post_conditional_logic', function(event, formId, fields, isInit){} );<\/script><script type='text\/javascript'> jQuery(document).ready(function(){jQuery(document).trigger('gform_post_render', [49, 1]) } ); <\/script>\n<\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-2 fusion_builder_column_1_3 1_3 fusion-flex-column\" style=\"--awb-padding-top:30px;--awb-padding-right:30px;--awb-padding-bottom:30px;--awb-padding-left:30px;--awb-overflow:hidden;--awb-bg-color:#fcf1f1;--awb-bg-color-hover:#fcf1f1;--awb-bg-size:cover;--awb-border-radius:30px 30px 30px 30px;--awb-width-large:33.333333333333%;--awb-margin-top-large:0px;--awb-spacing-right-large:5.76%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:5.76%;--awb-width-medium:33.333333333333%;--awb-order-medium:0;--awb-spacing-right-medium:5.76%;--awb-spacing-left-medium:5.76%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-text fusion-text-2\" style=\"--awb-font-size:24px;--awb-text-color:#191818;--awb-margin-top:10px;--awb-text-font-family:&quot;Open Sans&quot;;--awb-text-font-style:normal;--awb-text-font-weight:700;\"><p>Prefer a Live Person?<\/p>\n<\/div><div class=\"fusion-text fusion-text-3\" style=\"--awb-font-size:36px;--awb-text-color:#191818;--awb-margin-top:-20px;--awb-text-font-family:&quot;Open Sans&quot;;--awb-text-font-style:normal;--awb-text-font-weight:700;\"><p>1-855-346-5152<\/p>\n<\/div><div class=\"fusion-text fusion-text-4\" style=\"--awb-content-alignment:left;--awb-font-size:18px;--awb-line-height:24px;--awb-text-color:#520a1c;--awb-margin-top:-20px;--awb-text-font-family:&quot;Open Sans&quot;;--awb-text-font-style:normal;--awb-text-font-weight:400;\"><p>Nationwide scheduling hotline<br \/>\nMon-Fri | 8AM \u2013 5PM CST<\/p>\n<\/div><div class=\"fusion-text fusion-text-5\" style=\"--awb-content-alignment:left;--awb-font-size:18px;--awb-line-height:24px;--awb-text-color:#191818;--awb-text-font-family:&quot;Open Sans&quot;;--awb-text-font-style:normal;--awb-text-font-weight:400;\"><p><a href=\"https:\/\/radiologyassist.com\/StagingAvada\/contact-us\/\"><span style=\"color: #520a1c;\">More Contact Information<\/span><\/a><\/p>\n<\/div><div class=\"fusion-text fusion-text-6\" style=\"--awb-font-size:24px;--awb-text-color:#191818;--awb-text-font-family:&quot;Open Sans&quot;;--awb-text-font-style:normal;--awb-text-font-weight:700;\"><p>About Assist Health Group<\/p>\n<\/div><div class=\"fusion-text fusion-text-7\" style=\"--awb-content-alignment:left;--awb-font-size:18px;--awb-line-height:24px;--awb-text-color:#520a1c;--awb-margin-top:-20px;--awb-text-font-family:&quot;Open Sans&quot;;--awb-text-font-style:normal;--awb-text-font-weight:400;\"><p>Since 2010, Assist Health Group has offered high quality specialty managed care and disease management solutions through its concierge program. Our services are designed to be customer driven and outcome based.<\/p>\n<p>By focusing on maintaining a high quality of care, providing the best customer and provider service, and building strong relationships with our providers and payors, Assist Health has developed an innovative PPO network solution that provides the benefits for patients, providers and payors.<\/p>\n<\/div><\/div><\/div><\/div><\/div>","protected":false},"excerpt":{"rendered":"","protected":false},"author":15,"featured_media":0,"parent":12398,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"100-width.php","meta":{"footnotes":""},"class_list":["post-12425","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/radiologyassist.com\/StagingAvada\/wp-json\/wp\/v2\/pages\/12425","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/radiologyassist.com\/StagingAvada\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/radiologyassist.com\/StagingAvada\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/radiologyassist.com\/StagingAvada\/wp-json\/wp\/v2\/users\/15"}],"replies":[{"embeddable":true,"href":"https:\/\/radiologyassist.com\/StagingAvada\/wp-json\/wp\/v2\/comments?post=12425"}],"version-history":[{"count":0,"href":"https:\/\/radiologyassist.com\/StagingAvada\/wp-json\/wp\/v2\/pages\/12425\/revisions"}],"up":[{"embeddable":true,"href":"https:\/\/radiologyassist.com\/StagingAvada\/wp-json\/wp\/v2\/pages\/12398"}],"wp:attachment":[{"href":"https:\/\/radiologyassist.com\/StagingAvada\/wp-json\/wp\/v2\/media?parent=12425"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}