Name *

Please include any post-nominal credentials following your last name (example: Gonzalez, MPH)

First Name

Last Name

Are you currently in naturopathic medical school or have you graduated? *

Currently a naturopathic medical student

Graduated naturopathic medical school

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Please email all digital assets to hype@naturemed.org

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Please check off the box for the organization(s) you consent to us sharing your story with so they may publish it as well, or contact you to publish in another manner.

American Association of Naturopathic Physicians (AANP)

Association of Accredited Naturopathic Medical Colleges (AANMC)

Your current naturopathic medical school/alma mater naturopathic medical school

Your state association / state association where the school is located

Consent *

I give consent to the Institute for Natural Medicine ("INM") to use my name, photograph (if provided), and story for educational publicity, marketing, advertising, and fundraising purposes through all forms of media.