New Member Payment Page (for physical paper applications) | Vermont Association of Naturopathic Physicians

For New Members Choosing to Submit Physical Paper Application

This form will accept your payment and create an online account for your “Find a Physician” profile page. After payment, you will be redirected to a page where you can:

Download the printable member application
Download and print VANP by-laws
See instructions for faxing or mailing the printed application

New Member Payment

Name

First Last

Email(Required)

Phone

Username(Required)

IMPORTANT! This will be your user login for the "Find a Physician" page.

Password(Required)

Enter Password Confirm Password

IMPORTANT! This will be your user login password for the "Find a Physician" page.

Practice Name(Required)

Billing Address(Required)

Street Address City State ZIP Code

Credit Card

Card Details

Cardholder Name

Membership Type(Required)

Automatically Renewed Yearly

Total

Consent(Required)

I understand this renewals automatically.(Required)

For the convenience of our organization, we automatically set this to renew. But please know you can cancel the renewal.

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Naturopathic Principles

Naturopathic Therapies

Conditions Treated

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