This application is for first time applicants who are Naturopathic Doctors (NDs) who graduated from an accredited naturopathic medical program (recognized by the CNME) who hold a license to practice naturopathic medicine in a licensed state AND who are living and/or practicing in the state of Michigan.

If you are a renewing member, please click here.


    PROFESSIONAL MEMBERSHIP APPLICATION

    This application is for Naturopathic Doctors who graduated from an accredited naturopathic medical program (recognized by the CNME) who hold license to practice naturopathic medicine in a state where a license is available AND who are living and/or practicing in the state of Michigan.


    Personal Information

    (Personal Information is kept private and will not be posted online.)

    Name:

    Address: Email:

    Phone: Fax:


    Business Information*

    (Business Information will be posted online in the member directory.)

    Office Location 1

    Name:

    Address Line 1:

    Address Line 2:

    Email:

    Phone: Fax:

    Website:


    Office Location 2

    Name:

    Address: Email:

    Phone: Fax:

    Website:


    * Business Information not required for students or associate members.


    Membership Qualifications

    CNME Accredited Naturopathic School:

    Graduation Date

    Upload a copy of your license


    States/Provinces in Which You are Currently Licensed to Practice Naturopathic Medicine

    State License # Expiration date

    State License # Expiration date


    Has Your License to Practice Naturopathic Medicine Ever Been Suspended or Revoked? YesNo

    If yes, please explain


    Postgraduate Training in Naturopathic Medicine (Residencies, Internships)

    Area of specialty/Program/Institution:

    Date:


    Other Board Certifications/Past Licensures

    Licensure: Year(s) Granted:

    Licensure: Year(s) Granted:


    Professional References*

    References One

    Name

    Address

    Phone


    References Two

    Name

    Address

    Phone


    * References not required for renewals.


    MANP INVOLVEMENT

    Are you interested in participating in one of the following MANP Committees?

    EthicsFundraisingGrassrootsLegislativeMembershipPublic RelationsNot Interested At This Time


    SIGNATURE

    If accepted for membership in the MANP, I agree to abide by the MANP policies and by-laws, follow its Code of Ethics, and uphold the high standards of naturopathic practice.

    Signature Date


    Please select your payment method

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