Ambassador Program Sign Up

Become an Ambassador!

Help us spread the word!
Sign up for our Ambassador Program and receive rewards for every referral that is enrolled in a study!
By signing up to become a DM Ambassador, you can help advance research by spreading the word to your friends and family.

Simply follow the steps below to sign up:
1. Visit the DM Clinical website or scan the QR code on Ambassador flyers.
2. Fill out a registration form with your personal information (e.g., name, email, and active contact details).
3. Submit the form.
4. A unique Ambassador link will be generated and sent to your email, also displayed on-screen.
5. As an Ambassador, you can share their link with referrals, who can sign up for a study through it by following the website prompts.
Guidelines:
- Once you sign up as an Ambassador, you will receive a personalized referral link to share with your friends and family via social media, text, or messaging apps.
- Anyone you chose to refer MUST use your personalised referral link to sign up for a study; direct calls or non-link sign-ups will not be accepted.
- Referral rewards (gift cards) will be issued to the Ambassador only if the referred individuals enroll (randomize) in the study.
- Enrollment timelines vary; referral rewards are typically sent within a few months of enrollment.
- There is no limit on the number of people you can refer or rewards you can earn.
- First Name*
- Last Name*
- Phone Number*
- Are you currently an employee of DM Clinical Research?*
  
  YesNo
- RCode
- Submit date
  
  MonthDayYear
  Date
  Hour Minutes
- Email*
  example@example.com
- How did you hear about us?*
  
  Social Media AdvertisingAmbassador FlyerEmail/text messagePhysicianPatient Enrollment Specialist
- Name of Patient Enrollment Specialist*
- Crio ID (if current participant)
- If you are signing up for someone else, please provide your name below:
- Is there someone you would like to refer at this time?*
  
  YesNo
- Referral's Name*
  
  First NameLast Name
- Referral's Email*
  example@example.com
- Referral's Phone Number*
  Please enter a valid phone number.
- - By submitting a referral through this form you hereby confirm that you have obtained your referral's permission to receive a one-time invitation by email from DM Clinical Research regarding our clinical trials.
  - By submitting this form, you agree to the terms and conditions of the program. Please note that the compensation will only be provided for successfully enrolled referrals.
- By submitting this form, you agree to the terms and conditions of the program. Please note that the compensation will only be provided for successfully enrolled referrals.
- Should be Empty:

Become an Ambassador!