Apply for Membership Archives - National Navigation Roundtable

Organization Name/Type*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Website

Name - Proposed Representative*

First Last

Position/Title/Credentials*

Email*

Preferred Telephone Number

Name - Proposed 2nd Representative

First Last

Position/Title/Credentials

Email

Membership Category (Check all that apply)*

Organizational/Institutional
Individual (by invitation only)
Corporate

Focus of your Organization's Navigation Impact*

National
Regional (parts of multiple states)
Local (one state or less than one state)

Other, please specify

The NNRT Roundtable is committed to facilitating interaction and collaboration between members who are highly engaged as a catalyst to initiate work on key issues around patient navigation. Briefly describe how you or your organization/institution meets one or more of the following membership criteria. Feel free to highlight areas of expertise you/your organization can offer NNRT and to attach supporting documents. • Have a strong interest in reducing health disparities through patient navigation. • Have demonstrated expertise and reputation in navigation programs and /or research. • Have demonstrated expertise in patient navigation across the cancer continuum of care. • Have the ability to deliver navigation education. • Have the ability to deliver navigation services. • Has experience/expertise in a field related to patient navigation that could assist in advancing the goals of the NNRT*

Please describe the perceived benefits of participating in NNRT for you and/or for your organization.*

NNRT Members should: a) Agree to advance the goals of NNRT. b) Attend the National Meeting to maintain membership. c) Participate in one Committee or Task Group.*

I agree
I do not agree

Please rank in order of preference, with 1 being the highest preference Task Groups you are interested in participating in. (Primary Representative)*

Other, Please specify

Please rank in order of preference, with 1 being the highest preference Task Groups you are interested in participating in. (Secondary Representative)

Other, Please specify

Membership Application

Tag: Apply for Membership