ICOSEP offers free membership to qualifying patient advocate and medical organizations. First, review our Privacy Regulations. Then, fill out the form below. When we process your application you will receive a response.

Thank you for joining this amazing effort!

[contact-form to=”jamie@icosep.org” subject=”Membership Application”][contact-field label=”Name” type=”name” required=”1″][contact-field label=”Email” type=”email” required=”1″][contact-field label=”Organization Name – Position” type=”name” required=”1″][contact-field label=”Organization Website” type=”url” required=”1″][contact-field label=”Is the Organization for Adults or Children” type=”select” required=”1″ options=”Adults,Children,Both”][contact-field label=”Medical Conditions the Organization Covers” type=”text” required=”1″][contact-field label=”Also Sign Up for Friday Email?” type=”checkbox” required=”1″][contact-field label=”Electronic Signature” type=”text” required=”1″][/contact-form]

By clicking submit, you and/or your organization agree to participate in the International Children’s Growth Awareness Day campaign, September 20th, each year. Participation includes posting information to include pictures, blogs, awareness videos, or other announcements via your social media outlets. This agreement also includes the acknowledgement to receive emails and publications from ICOSEP, The MAGIC Foundation, and affiliates. Regulations can be read by clicking here.

Translate »