Active Elements

Getting Started Quickly

  • Enrol as an Active Elements professional member by completing this form (bona fide health care practitioners only) and access the professional information area of our website.

Retailer Registration

Join us as an Active Elements Retailer and instantly receive the following free benefits:

  • Online ordering (freight free for orders of 6 or more units).
  • Generous quantity discounts (automatically applied).
  • Access to promotional text and graphics.
  • Access to our in-store customer ‘Formula Selector’ tool.

* Required fields.

Personal Details

* Title
* First Name
* Last Name
* Email Address
* Contact Phone
Country Code, Area Code and Local Number
* Country

Business Details

* Your Business Name

If you are experiencing difficulty completing this form or require further information or assistance, please contact us.