Stay Updated with Our Newsletter and Our CME Programs!  Earn CME/CE Credits Sign Up Now to Get Our Newsletter and More! DEF Newsletter Sign-up "*" indicates required fields Name* First Last Name Middle Suffix Email* Category (Select from drop-down)*Nurse PractitionerPhysician AssistantPhysicianResidentNurseMedical AssistantBiologic CoordinatorOffice ManagerIndustryStudentPharmacistDegree (Check all that apply)* DNP DO LPN MBA MD MPAS MPH MS MSN NP-C NP PA-C PA PhD RN Other How many years have you practiced in dermatology?* 0-5 years 6-10 years 11-15 years 16-20 years 21+ years Primary Practice, Company, or Institution Name* Preferred Mailing Address Line 1* Preferred Mailing Address Line 2 Address Type* Business Residence City* State*AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificZIP Code* State of Residence*AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificNPI Number* Mobile Phone NumberPlease indicate the average number of patients you see in a typical clinic day.*0-1011-2021-3031-4041-5051-6061-7071+Select any areas in which you have interest in participating.* Medical Dermatology Aesthetic Medicine/Cosmetic Dermatology Pediatric Dermatology Clinical Trials and Research Advisory Board Opportunities with Industry Thinking of educational opportunities, select all topics you are interested in learning more about.* Medical Dermatology Aesthetic Dermatology Pediatric Dermatology Practice Management Contracting/Negotiating Billing/Coding Meetings/Events in Dermatology Dermatology Industry News Emerging Therapeutics Skincare and Cosmeceuticals Energy-based Devices Diagnostic Tests Dermatopathology CME/CE Educational Opportunities Virtual Journal Clubs Please mark any associations to which you belong.* American Academy of Dermatology Dermatology Nurses' Association Society of Dermatology Physician Assistants State/Regional Dermatology NP Society State/Regional Dermatology PA Society How did you hear about DEF?*Colleague/FriendLocal/Regional PA or NP SocietyDEF WebsiteSocial MediaAttended a DEF EventOtherWhat are your favorite medical journals/periodicals? Add RemoveWhat is your favorite live medical education conference? Add RemoveWhat are your favorite medical/dermatology online resources? Add RemoveDo you agree to receive electronic communication from Dermatology Education Foundation (DEF) ?* Yes No No contact information will be shared with or sold to any third party. Information will be used in accordance with our Privacy Policy: dermnppa.org/privacy/CommentsThis field is for validation purposes and should be left unchanged.
