Student Membership Application

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Name*

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

Phone*

Fax

CNME Accredited Naturopathic School

Expected Graduation Date (MM/DD/YY)

Upload a copy of your current student ID

Max. file size: 512 MB.

Are you interested in participating in the ongoing activities of MAND?*

Interested in full year participation on a MAND committee

Interested in volunteering for specific tasks

Not interested at this time

If yes to committee participation, which committee would you like to be involved in?

Ethics

Fundraising

Grassroots

Legislative

Membership

Public Relations

The appropriate committee will be contacting you in the near future.

Signature*

Date*

Please select your payment method*

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