Membership Application

Membership Application

This form can be used to apply for IPPS membership. Your membership application will be reviewed within 5 business days, and we will send your approval by email.

All data submitted on this form will be processed on a Secure Server (SSL), which is owned and maintained by the company managing the IPPS Executive Office 'Status Plus B.V.' in The Netherlands. For more information please contact us by phone +1 (612) 474-4140 or e-mail info@pelvicpain.org.

Personal details

For example, Dr., Prof.

For example, Jr., Sr., II etc.
For example, MD, PhD etc.

Home address

Work address

Billing address

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Information

Diverse health care

Fostering education, awareness, and hope to improve pain and restore quality of life.

Contact

International Pelvic Pain Society
14305 Southcross Drive West, Suite 100
Burnsville, MN 55306
U.S.A
Telephone: +1 (612) 474-4140
Fax: +1 (952) 314-8212
Email: info@pelvicpain.org