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50 Sugden Street Bergenfield, New Jersey 07621 | Phone: (201)-387-1504 | Fax: (201) 387-1505 | Email: info@lifeaftercancernetwork.org
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Natural Health Care Provider Consent and Release

As expected I am accountable and responsible for my behavior, individually and as a registered natural health care provider member of Life After Cancer Network. I do herby consent and agree to abide by the ethics contained in the registered natural health care provider agreement and the governing documents and policies of Life After Cancer Network.

I will abide by my scope of practice observing high standards of legal and ethical conduct and comply with all applicable state and federal laws, rules and regulations. I will renounce from any form of harassment, discrimination, illegal, derogatory or unethical conduct, and I understand that if I engage in such conduct, I agree to reimburse Life After Cancer Network for any damages, losses, or costs resulting from my conduct. I acknowledge that Life After Cancer Network cannot effectively screen, oversee, monitor or supervise every registered natural health care provider and therefore, I release and discharge Life After Cancer Network’s directors, officers, employees, agents, sponsors and other registered natural healthcare providers from any liability for the intentional or negligent acts or omissions on my behalf.

By submitting and clicking the terms of the Natural Health Care Provider Consent and Release | Natural Health Care Provider Agreement , I agree to the collection, use and processing of the personal information I provide to Life After Cancer Network’s application for the purposes of organization administration, payment of my tax-deductible membership, and inclusion of my contact information in the natural heath care provider’s website that will be distributed to members for the purpose of providing professional health advice to its members. By submitting my personal information to Life After Cancer Network, I also agree that my information may be accessed and used by its directors, officers and employees. I agree to notify addresschanges@lifeaftercancernetwork.org of any change to my personal information, including making any requests to check, correct or remove my personal information if I decide to no longer be a registered natural health care member, so that it is accurate and current. I understand that the majority of information required to apply is necessary for administrative, payment purposes and planning purposes. Failure to provide this information may prevent my application from being properly processed or inclusion of my contact information for members to contact me. I confirm that this completed new member application is on file with Life After Cancer Network and will be retained by the organization. I have agreed to submit this application by electronic means. By clicking the terms of the Natural Health Care Provider Consent and Release | Natural Health Care Provider Agreement, I fully understand the statements of this application. I understand that agreeing to and clicking the terms has the same legal acknowledgement as a written signature. By clicking below, I agree to the terms of the registered natural health care provider agreement and the natural health care provider consent and release. I affirm that I am in good standing in my profession in the state which I practice.

Any questions should be directed to: registeredmembers@lifeaftercancernetwork.org

Natural Health Care Provider Agreement

As a registered natural health care provider I agree to:

Provide professional and compassionate natural health care advice to cancer survivors, friends, families and caregivers when contacted.

Provide professional, quality health advice and suggestions to our members, observing high standards of legal and ethical conduct and complying with all applicable state and federal laws, rules and regulations.

Be committed to Life After Cancer Network’s mission, demonstrated by how well we treat cancer survivors, family, friends and caregivers.

Recognize that caregivers, family and friends are essential team members in supporting and encouraging a cancer survivor towards a healthier lifestyle.

When contacted, provide appropriate, responsible and efficient responses in a timely and effective manner.

If called upon, to meet the needs of survivors, family, friends and caregivers in a comfortable and safe office environment.

Empower cancer survivors, family members, friends and caregivers to make beneficial choices for their well-being and restoration of health.

Become part of the fabric of each community we serve, committed to excellence in improving the well-being and quality of life of survivors, family, friends and caregivers with a civic sense of duty.

I understand that my agreement with Life After Cancer Network is on a monthly subscription basis starting from the date which I enrolled.

I understand that enrolling any day in a month constitutes a full month’s subscription.

I understand either party may terminate this membership agreement at any time, with or without cause, by giving the other party thirty (30) days written notice to terminate.

Any questions should be directed to: registeredmembers@lifeaftercancernetwork.org

Natural Health Care Provider Membership
  • For $49.99/month or($540 for payment in full) per year you will receive the following benefits:
  • A tax deduction for your monthly/yearly donation
  • Certification of Membership
  • Use of the Life After Cancer Network trademarked logo
  • Approved registration and participation on the Life After Cancer Network's website putting you in direct contact with cancer survivor's in your area.
  • Use of the Cancer Network App
  • A FREE Powerpoint presentation sent to you quarterly specifically designed for cancer survivors for each year you are a member to do workshops and presentation in your community.
  • A quaterly Life After Cancer Network e-newsletter.