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Organizational Membership Application Form

Yes, I support the vision and mission of PAINS and commit to share information, collaborate and work together to transform the way pain is perceived, judged and treated!

If you have questions, please contact us.

Note: Membership does not constitute any financial or legal obligations, as well as endorsement of all position papers, policies and press releases from PAINS.

* indicates required

Name of organization/institution/agency/company

*Website

Address

City

State

Zip

Email Address
*

Phone Number
*

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Primary Contact: First Name
*

Primary Contact: Last Name
*

Title/Position

Are you authorized by your Organization/Institution/Company to join PAINS?*

Can we list your group on our website as a member?*

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Organizational Membership Application Form

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