Primary Care Network

Membership Registration

Why Become a Member?

►Create your new Primary Care Membership!

Items in bold are required

First Name	M.I.	Last Name	Suffix
Title or Degree		Specialty	Gender
Practice / Business Name
Mailing Address
City	State	Zip
Telephone		Fax
Email Address (We will use this email address to forward your account information in the event your username or password is forgotten) Password: Password (again):

Tell us about yourself and your practice:

Are you currently:	in practice?
	in residence? If so, year in residency:
	not in practice?

Year you began to practice:

Practice setting:

Number of doctors in your practice?

Number of patients per week?

Which type of continuing education programs do you prefer? (Check all that apply)

Live Conference - Didactic
Live Conference - Workshop
Live Conference - Combination
CD-ROM

Web Based
Audio CD
Monographs
Other

Which live conference formats do you prefer? (Check all that apply)

Multiple Day (10+ Hours CME)

2 Hour Dinner Program (2 Hours CME)

Whole Day (6-8 Hours CME)

1 Hour Dinner Program (1 Hour CME)

Half Day (4-6 Hours CME)

1/2 Hour Lunch Program (1/2 Hour CME)

Teleconference (1-2 Hours CME)

CME Credit Type:

Board Certified:

How did you hear about PCN?

Categories of Interest:

Acute Pain
ADHD
Adherence / Patient Care
Allergic Rhinitis
Alternative Medicine
Alzheimer’s / Dementia
Anemia
Anxiety
Arrhythmias
Asthma
Autism
Benign Prostatic Hypertrophy
Bioterrorism
Bipolar
Blood Disorders
Bronchitis
Cancer in Primary Care
Chronic Pain
CNS Infections
COPD
Critical Care
Depression
Diabetes
Disaster Relief & Treatment
Dissociative Disorder
Dysfunctional Uterine Bleeding
Dyslipidemia
Ear / Nose / Throat (ENT) Disorders
Eating Disorders
Endometriosis
Epilepsy / Seizures
Erectile Dysfunction
Eye Disorders
Genetics
GERD
GI Motility Disorders
Heart Failure
Hormone Replacement Therapy
Hypertension
Infectious Disease

Learning Disabilities
Lower Respiratory Infections
Medicare / Medicaid
Menopause
Men’s Health
Metabolic Disorder
Migraine
Movement Disorders
Musculoskeletal Disorders
Neuropathic Pain
Obesity
Osteoarthritis
Osteoporosis
Overactive Bladder
Pain Management
Pelvic Inflammatory Disease
Personality Disorders
Pharmacotherapy
Phobias
Physical / Mental Abuse
Pituitary Gland Disorders
Polycystic Ovarian Syndrome
Post Traumatic Stress Disorder
Psychosis
Psychotherapy
Renal Disorders
Rheumatoid Arthritis
Schizophrenia
Sexual Health
Sinusitis
Skin / Soft Tissue Disorders
Sleep Disorders
Sports Injuries
Stress Urinary Incontinence
Technology in Medicine
Thyroid Disorders
Upper Respiratory Tract Infections
Urge Urinary Incontinence
Vascular Disorders
Women’s Health

Acknowledgement: By creating this account I acknowledge that I may receive mail, email, and/or faxed invitations to CME conferences from Primary Care Network. As a member, I recognize that I may be asked to participate in quarterly surveys regarding my practice, current techniques, my opinion on matters of medical relevance, and to guage interest in therepeutic areas for future CME programs.

Primary Care Network will not distribute or sell your information.

Education - Stay at the Leading Edge of Therapeutics!
·	Primary Care Network offers CME accredited courses through a variety of formats: nationwide seminars, symposia, teleconferences, as well as online and interactive education for the healthcare provider on the go.
·	Primary Care Network Members receive early notice of upcoming events via mailed invitation, email, fax, our Primary Issues newsletter, and the Primary Care Network website.
·	Primary Care Network Members also receive access to previous educational presentations featured at various national symposia.
·	Primary Care Network Members receive access to the members-only area of our website to read and participate in our blog, exclusive online CME, and much more!

Help Direct Primary Care Network's Future Education Efforts
	Let your voice be heard! What therapeutic areas would you like to see offered in future CME programs? As a member of Primary Care Network, you will be asked to help guide the curriculum through your response to quarterly surveys. Your opinion is important to us, and together, we can bring practitioners the informative programs needed most.

Research Opportunities
	Advancement of medicine through clinical research is a principal goal of Primary Care Network. Primary Care Network selects investigative sites from across the country each year to participate in the latest clinical trials and innovative therapy research. These research sites are recruited from the Network’s member list. If you think that you would like to be a part of these pioneering efforts, now is your chance to contribute to an upcoming study!

Join the Prestigious Primary Care Network Faculty
	Primary Care Network is always looking for qualified speakers to help facilitate our CME programs. The Primary Care Network faculty currently includes over 100 facilitators and key opinion leaders nationwide. Many started by attending one of our programs. Do you have a passion for teaching? Would you like to study the newest therapeutic approaches and convey that knowledge to your peers? If this appeals to you, you could become a part of our elite teaching staff!

And That's Not All...
	All Primary Care Network members receive our informative bi-monthly Primary Issues newsletter. Every two months members receive via email one or two CME articles - timely articles featuring cutting edge therapeutic treatments, effective strategies for patient care, CME program updates, and profiles of our successful members.

Membership Qualifications
·	Sign up – Simply complete the membership agreement form to the right on this page and answer a few basic questions about you and your practice that will help us help you.
·	Participate – Join in quarterly surveys that will help determine the direction of our future educational and research efforts.

Who Should Join Primary Care Network?
	Any healthcare provider who is interested in innovative treatment strategies for his/her patients.