NCPIE: National Council on Patient Information and Education

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Please consult a licensed health care professional with questions or concerns about your medication and/or condition.

Last Updated
November 4, 2008

ABOUT US > Membership

Welcome | Member Benefits | Membership Application | Roster of NCPIE Members

Membership Application

1. Your Information

Business Title

First Name*

Last Name*

Medical Title(s) (PhD, MD)

Organization Name*

Address

City

State

Zip

Country (if outside US)

Telephone

Fax

E-mail

Website

How did you learn about the National Council?

Required Field *

2. My organization is best described as (check one)

Dues Level

	Public sector, consumer and/or patient advocacy group; university, chapter and affiliate of national organization; and state or regional non-profit managed care organization	$150
	National or international non-profit health professional organization and health-related trade association; and state or regional for-profit company.	$750
	National or international for-profit company, including pharmaceutical manufacturers and managed care organizations.	$7,500

3. Committees

Please check the committee(s) below on which you would like to serve:

Consumer Medicine Information	Conference	Membership	Public Relations

4. Tax-Deductible Contribution

We thank you for your tax-deductible contribution! Any amount is greatly appreciated.

I would like to contribute the following amount:

5. Submit Application

NCPIE's Membership Year is January-December. We look forward to welcoming you to our coalition!

Please push Submit to proceed with your application for NCPIE membership. You will be redirected to our secure online payment site.

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NCPIE 4915 Saint Elmo Ave., Suite 505 Bethesda, MD 20814-6082		Phone Fax Email	(301) 656-8565 (301) 656-4464 ncpie@ncpie.info