MEMBERSHIP APPLICATION – LICENSED PHYSICIANS

Except as required by law, the information entered will not be shared with the public or any other organization.

  • By clicking “submit”, you give PPN permission to send occasional emails and newsletters to the provided email address via the newsletter service, Constant Contact. The ability to opt out will appear on the bottom of each newsletter.
  • By ticking the box “I would like to be added to the online PPN Practitioner Directory”, you agree to have your medical practice information shared via email and listed online at www.pandasppn.org/practitioners. Your email address will be kept private.
  • Contact PPN at support@pandasppn.org if you wish to edit or delete any part of your membership or be sent a copy of your membership information.
  • See PPN’s Privacy Policy for additional information.