NCPIE: National Council on Patient Information and Education

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Last Updated
July 29, 2010

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 NCPIE?

* 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. Submit Application

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

PayPal - Visa, MasterCard, American Express, Discover Your application will be submitted after this page, but your membership will not be activated until your membership dues are paid on the next page. NCPIE accepts Visa, MasterCard, American Express, Discover Card, and e-checks as well as PayPal.

If you prefer to purchase your membership by mail or fax, fill out the Membership Application form and send it with your payment to:

National Council on Patient Information and Education (NCPIE)
200-A Monroe Street, Suite 212
Rockville, MD 20850-4844
Fax (301) 340-3944

Once your membership is processed, NCPIE will send you a "Welcome" letter and packet of our popular educational resources. Please contact NCPIE if you have any questions.

Please push "Submit" to proceed with your application for NCPIE membership.

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NCPIE 200-A Monroe Street, Suite 212 Rockville, MD 20850-4448		Phone Fax Email	(301) 340-3940 (301) 340-3944 ncpie@ncpie.info