Membership Registration Form

Thank you for your interest in joining the MPN Advocates Network.

Patient organizations are eligible to apply for membership of MPNAN, as long as they meet the following criteria:

  • Have a sole or partial focus on providing services to and/or supporting patients with MPN.
  • Are recognized as a non-profit organisation in good standing in their country.
  • Are willing to work with and cooperate with other member organisations with the same objectives.

If you do not currently meet the criteria for membership but are interested in starting a MPN group in your own country, please email info@mpn-advocates.net 


    Organisation


    Contact







    Social media - Insert link


    Update regularly?
    Open or private portal?



    Update regularly?
    Open or private portal?



    Update regularly?
    Open or private portal?



    Update regularly?
    Open or private portal?



    Update regularly?
    Open or private portal?



    Update regularly?
    Open or private portal?


    Website - Insert link

    Please provide a brief description of your organization, including the programs, activities or services that support patients with MPN:

    Your organization has experience in the following topics that could contribute to MPNAN:

    Number of members or patients your organization represents today:

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    Upload the logo of your organisation