2025 SMSNA - APP Outreach Program Registration Form

Registration is required only ONCE to attend the entire 6-webinar series.

Name*

Title (Mr., Ms., Miss, Dr., etc.)First NameLast NameSuffix

Credentials*

Gender*

Email*

Email given will be used for member profile

Secondary Email

Type N/A if does not apply

Organization*

Primary Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Primary Address is:*

Organization Website

Choose your specialty*

If other, please specify:

Please choose one of the following:*

I am a current, active member of SMSNAI was previously an APP member of SMSNA and now wish to renew to take advantage of this free course. I understand renewing does constitute a renewal fee of $80.00.I am brand new to SMSNA and am also an APPI am not an APP; however I am very much interested in registering for this free course.

If you are not a current member of SMSNA, are NOT an APP and still wish to join, please check the box below.

I wish to apply for membership to SMSNA

Please provide a brief statement of your interest in joining the SMSNA and in sexual medicine*

0/0

Acknowledgements*

The information provided in this registration will be used to create a profile in the SMSNA membership system for free SMSNA APP/AHP membership through December 31, 2025 (applies to new APP/AHP members only).By registering for this web series, you will be automatically registered (free of charge) for all dates in the 2025 series.*By clicking "Submit" you are opting in to receive special communications from SMSNA regarding the SMSNA Advanced Practice Providers Webinar Series.By checking this box, you are giving SMSNA permission to share your First Name, Last Name, Credentials, and Organization with Endo Men's Health.

* All webinars will be recorded and made available (along with associated course materials - i.e. slide decks/presentations) to all active SMSNA members by logging into your membership account and visiting the appropriate course page on the SMSNA website. These recordings are only available to active SMSNA members.

Registration is required only ONCE to attend the entire webinar series.

SMSNA Advanced Practice Providers Webinar Series Registration 2025