This agreement is between The Dental Matrix (“TDM”) and member dentists (“Member”). By submitting this form Member hereby gives TDM permission to use Member’s name and information for the purpose of contract negotiation with third parties such as dental materials suppliers, labs and services, professional services, etc. Member’s information will not be sold nor used for any other outside third-party advertisement. Member will be informed of new partner contracts, changes in product offerings, etc. Further, Member hereby authorizes TDM to charge their credit card a recurring amount monthly, as indicated above. Member must provide TDM 30 days written notice for cancellation of charges and accompanying membership benefits.