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MPN AN Membership Registration Form
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Thank you for your interest in joining the MPN Advocates Network.

Patient organizations are eligible to apply for membership of MPNAN, as long as they meet the following criteria:

If you do not currently meet the criteria for membership but are interested in starting a MPN group in your own country, please email 

Please provide the following personal information:

Name of Organization

Registrations Number

Contact Name




Telephone #


Social Media Platform
(Facebook, Twitter, etc.)

Updated Regularly?

Yes or No

Private or

Open Portal

Social Media #1

Social Media #2

Social Media #3

Social Media #4



Please provide a brief description of your organization, including the programs, activities or services that support patients with MPN:










Your organization has experience in the following topics that could contribute to MPNAN:









Number of members or patients your organization represents today:

If you have any questions, comments or concerns, please list them here or email us at