Membership Sign-up form

*** IMPORTANT ***

Do you work in Paediatrics? Please join our Paediatrics neurotoxin network.

This allows us to provide both Paediatrics and Adult Neurotoxin Networks. Thank You.

Please fill out the form below to apply or to renew your annual membership.

Your Current Status

Information for former Botox injectors

If you are no longer actively providing Botox treatments, or have retired, but wish to continue to be a member of the BNN, please email us at membership@neurotoxinnetwork.org. We will then remove your listing from the map and provide you with details on how to continue with your membership.
Thank you for being part of the BNN.

Your Profile Details

Hospital Details

If you select "Yes", please complete the Additional Hospital Information section below providing the new hospital details. All other information, such as Position Title, Department, Conditions treated, and Technique used will be taken from the primary listing. Thank You.

Additional Hospital Information

Confirmation of Data