Membership Application

NEW MEMBER APPLICATION:
Please be aware that this membership application is quite comprehensive and will take a few minutes to complete. You will be asked questions about yourself, your interests and where you found out about World Institute of Pain. In order to join online you will also need your credit/debit card details to hand.

I wish to apply for membership of:   World Institute of Pain.
 
Membership Category: FIPP-Member WBrate
Period Valid For: 12 months
Fee Amount Due: 100.00 USD
 
The above Fee Amount Due must be paid by debit/credit card through AuthorizeNet as part of the registration process.
Click the button below to begin the application process.

(Please re-register if a previous application was not completed)
 
By completing the application form, you agree to be bound by any rules or terms and conditions that may apply.



We respect your privacy and will never knowingly disclose any of your details to any third party without your permission unless we are required to do so in order to comply with a legal notice served under UK law.

Data Protection Act: This group abides by the principles of the Data Protection Act 1988.

By completing this form you confirm that you consent (or have obtained the consent of the person concerned) to have these registration details recorded in a database for the purposes of Group administration.

This information will be saved such that it will only be visible to the management of this Group. If you wish your details to be made available to the other members of this Group, you must arrange this with the management of the Group or set such permissions yourself in the system security function (if made available to you).


This is a secure subscription service operated on behalf of: World Institute of Pain.
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World Institute of Pain® (WIP) is registered in compliance with s. 496.405 of the State of Florida Statutes, the Solicitation of Contributions Act. Registration #: CH52426.

     “A COPY OF THE OFFICIAL REGISTRATION AND FINANCIAL INFORMATION MAY BE OBTAINED FROM THE DIVISION OF CONSUMER SERVICES BY CALLING TOLL-FREE (800-435-7352) WITHIN THE STATE. REGISTRATION DOES NOT IMPLY ENDORSEMENT, APPROVAL, OR RECOMMENDATION BY THE STATE.”

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