Just and compassionate quality pharmaceutical services for ALL

Adhésion

Home Adhésion

Adhésion

Devenez membre de EPN en suivant ces étapes::

  1. Remplissez le formulaire en ligne “Rejoignez-nous en tant qu’individu”; ou “Rejoignez-nous en tant qu’organisation”.
  2. Nous serons en contact avec vous dès que nous recevrons votre formulaire complété à:
    • Demandez des informations supplémentaires si nécessaire
    • Ordre de paiement (Pour que la candidature soit prise en compte, le demandeur doit s’acquitter d’une taxe de candidature qui sera convertie en frais d’abonnement de la première année lors de son acceptation dans le réseau)

Member Application

EPN accepts applications of both individual entities and organizations.

Apply As An Individual

Apply As An Organization

Organisation Assessment

Before you fill in this application, we would like you to take a short assessment to determine if you will be a good fit for EPN. Please fill in your organisation's details answer the questions below.

1. What is your primary or core business?

2. Please describe the ownership of your institution.

3. Please select an option that best describes your institution.

4. What is the nature of your institution

5. How would you describe the reach of your institution?

6. Were you recommended to apply for this membership? If you were recommended, you will be required to upload the recommendation letter. If you do not have a recommendation letter, select 'No, I do not have any recommendation'.

Basic Information
Organization's Employees for Contact

Please provide details of the people in your organization, i.e the head of the institution, the person in charge of health/pharmaceutical services, the person in charge of training, the person in charge of communication and the person in charge of finance/accounts as well as any other person you feel may be important for the relationship with EPN. At least one person other than yourself is required.

1st Person
Organisational Nature and Structure
Type of Organization

Details of Organisation

Please provide/attach a brochure and most recent annual report of your organization.

File
Information provide by

Please note that any organization wishing to become an EPN member should complete this EPN membership application form. In order for the application to be considered, the applicant must pay an application fee which upon acceptance into the network will be converted into the first year’s subscription fee. The annual membership fee is currently 150 USD for organizations . We will be in touch with you as soon as we receive your completed form. Thank you very much for your interest to join EPN!

Individual Assessment

Before you fill in this application, we would like you to take a short assessment to determine if you will be a good fit for EPN. Please fill in your details and answer the questions below.

1. Why would you like to join EPN?

2. What is your area of expertise?

3. What best describes the nature of your work?

4. What is your religious affiliation?

Individual Information
Contact Information
Background Information

Please note that any individual wishing to become an EPN member should complete this EPN membership application form. In order for the application to be considered, the applicant must pay an application fee which upon acceptance into the network will be converted into the first year's subscription fee. The annual membership fee is currently 100 USD for indivuduals. We will be in touch with you as soon as we receive your completed form. Thank you very much for your interest to join EPN!

English