Vitiligo Support International - HomePhototherapy Registration.

As a VSI Member you are eligible for discounts on selected products sold by Amjo Corp. To qualify we do request that you complete the form below and register with us. Assuming you are a member of Vitiligo Support International (www.VitiligoSupport.org) then you qualify for a maximum 10% discount on purchases of UV Phototherapy Items (over $500.00). In the next ten years, you qualify for a 10% discount in the future for the re-lamping of your unit. We also will provide you with a bonus cash payment for purchases made by someone that you referred to Amjo. Full details on these discounts, awards or bonuses will be sent to you by email after you complete this registration.

www.VitiligoSupport.org Member Logon ID: *

First Name: *

Last Name: *

Address: *

Address:

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Phone Number: *

Your Fax Number:

Your eMail address: *

Please ensure that you provide a complete and accurate email address.
Following submission of this form you will receive an email from "chris@cane.com".
Please make sure that any spam blocking programs that you are using allow
emails from the domain "cane.com" and/or "HomePhototherapy.com".

Tell us a little about yourself and your Vitiligo. How much of your body is involved?

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