New Member Registration

Membership registration is available for healthcare professionals and their staff, schools, and government customers only. If you are unsure of your eligibility, please use the online chat, email our team at info@bernell.com, or call us at 574-259-2070.

There will be two parts to the registration form. Please remember the email address and password you enter on this initial form, as that information will be required to login as a member.

Note: * Indicates a required field

Contact Information

* First Name:

* Last Name:

*Title:

Company or Practice:

* Billing Address:

* City:

* Country:

* State/ Province:

* Postal Code:

* Email Address:

* Phone Number:

* Password:

* Confirm Password:

Please do not send me additional info