Membership application

Patient / Advocate

Community membership for patients and advocates contributing to awareness, forums, and patient-centered change.

Patient / Advocate Membership

Community membership for patients and advocates contributing to awareness, forums, and patient-centered change.

Tell the committee how you would like to participate, provide any optional supporting materials, and save a payment method for approval.

Account and contact details

Full Name *Email Address *Password *Confirm Password *Phone Number *

Mailing Address

Street and Number *ZIP / Postal Code *City *Country *

About you

Area(s) of Interest *

Research & ScienceClinical Care & Healthcare PracticePatient Advocacy & SupportEducation & TrainingPublic Health & PolicyChronic Infectious DiseasesIntegrative & Preventive HealthClinical Trials & InnovationCollaboration & NetworkingTechnology & Digital HealthCommunity OutreachGeneral Interest in CiPRESSOther

How did you hear about CIPRESS?

Advocacy & Engagement

Upload diagnosis letter or a brief statement of experience (optional)Describe how you would like to participate (e.g. advocacy, awareness, forums) *

Documents

Basic bio *Recommendation from a current CIPRESS member *I understand that all health documentation will remain confidential and will not be shared outside the review committee.

Final Confirmation

I confirm that the information provided is accurate.I agree to adhere to CIPRESS's code of conduct and values.I agree to pay the annual membership fee. Payment will only be collected once your application has been approved.

Chronic Infection Pathology Related Education and Science Society — Advancing research and education in chronic infection pathology.

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