Pull-thru Network Professional Membership Application and Services Information

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1 Pull-thru Network Professional Membership Application and Services Information Professional membership in the PTN includes access to all PTN publications and resources, but does not include access to member-to-member support (i.e., forums, chats, member referrals, etc.). Professional members are not eligible to vote in elections or to hold an office and will not have access to the members only area on the website. Professional membership is available as an Individual Membership or an Institutional Membership. Institutional membership includes professional membership for up to five individuals from one organization as well as a complimentary 1/4 page advertisement in the PTN News (3 consecutive issues, see attached Advertising Packet). **Please indicate if you would be willing to serve as a PTN Professional Advisor** Professional advisors are expected to actively support PTN s mission and provide various types of support to its membership. For example, advisors may provide answers to questions submitted by PTN members, speak at PTNsponsored events, submit articles or materials for PTN publications, and/or refer families to the PTN. Names and credentials of professional advisors will be publically available and listed in the PTN News and on the website. Professional advisors serve a term of 3 years, and may serve multiple terms. Please complete this form as completely as possible and return with your payment to: Lori Parker, Pull-thru Network, 1705 Wintergreen Pkwy, Normal, IL (309) or pullthrunetwork@gmail.com Please Check One: New Member Renewal Type of Membership: Individual Institutional (up to 5 professionals) 1. Name & Title: INSTITUTIONAL MEMBERS ONLY COMPLETE THE FOLLOWING AS NEEDED 2. Name & Title: 3. Name & Title:

2 4. Name & Title: 5. Name & Title: MEMBERSHIP FEES PTN Membership Fees ($50.00 USD per year, individual; $500 for institutional members) $ Donation (tax deductible) $ TOTAL ENCLOSED (Payable via check or money order to Pull-thru Network in US Dollars) $ Institutional members should additionally submit the attached Advertising Application in order to receive the complementary 1/4 page advertisement in the PTN News (3 consecutive issues) Professional Services PLEASE INDICATE WHICH DIAGNOSES YOUR PRACTICE COVERS (CHECK ALL THAT APPLY): Anal/Rectal Condition (please specify) Urogenital (please specify) low imperforate anus cloaca high imperforate anus cloacal exstrophy anal atresia bladder exstrophy anal stenosis hydronephrosis neurogenic bladder Hirschsprung Disease(please specify) renal defects short segment Hirschsprung Disease hypospadias long segment Hirschsprung Disease bifid scrotum total colonic Hirschsprung Disease chordia penis Other G.I. (please specify) Other Related Conditions (please specify) megacolon Cats-eye Syndrome pseudo-obstruction Down Syndrome Currarino triad Skeletal (please specify) Townes Brock Syndrome limb defects VATER/VACTERL Association scoliosis Caudal Regression Syndrome/Sacral Agenesis tethered spinal cord other WHICH OF THESE PROCEDURES DOES YOUR PRACTICE PERFORM? (CHECK ALL THAT APPLY): colostomy ileostomy urostomy vesicostomy colectomy anoplasty PSARP/pullthrough PSARVUP/cloaca repair pullthrough re-do ostomy closure prolapse repair tethered cord release sigmoid resection adhesions ureter reimplantation bladder augmentation MACE/Malone ACE or cecostomy Mitrofanoff procedure other

3 Advertising Policy Advertisements Must Be Clearly Identifiable The Pull-thru Network (PTN) believes that it is important for our members and readers of The PTN News to be able to distinguish advertisements from our health related information. For this reason, all advertisements are separated from our health information. It is clearly labeled, for example, with the word Advertisement running along the top or side of the box in which the advertisement appears. The Pull-thru Network Maintains Complete Editorial Independence The PTN maintains absolute editorial independence. Advertisers have no advance knowledge of our editorial content, nor does the editor shape content to accommodate advertising. The PTN News will not sell advertising for a specific product on the condition that it appears in the same location and at the same time as a specific article mentioning that product. Advertisers have no control over any of our editorial decisions or advertising policies. The Pull-thru Network Does Not Endorse Products The appearance of advertisements or sponsorship acknowledgements in The PTN News is not a guarantee or an endorsement by the PTN of any company, product or service or the claims made for the product or service in the advertisement or sponsorship acknowledgement. Some Types of Advertisements Are Not Accepted The PTN does not accept advertising that we know, or in our opinion, either contains false or misleading claims or promotes ineffective or dangerous products. The PTN does not accept advertising for alcohol, tobacco, firearms or pornography. We will not permit at any time the placement of any advertising for illegal or objectionable products. Advertising must not contain fraudulent, deceptive, nor offensive material, including material that misrepresents, ridicules, or attacks an individual or group on the basis of age, color, national origin, race, religion, sex, sexual orientation, or disability. The PTN News Contains No Advertorials The PTN does not accept advertorial articles. In other words, the newsletter does not contain consumer health articles which promote the products and services of advertisers and which have been provided by companies who advertise in The PTN News. The Editor Retains the Right to Reject, Cancel, or Remove Advertisements The PTN reserves the right to reject, cancel or remove at any time any advertising for any reason and will provide prompt notice to the advertiser upon rejection, cancellation, or removal of any advertising, together with an explanation following such action. The Pull-thru Network also reserves the right to determine the appropriate placement of the advertising in The PTN News. Legal Compliance of Advertisements It is the responsibility of the Advertiser to comply with all applicable domestic and foreign laws, including applicable laws and regulations or regulatory bodies. This includes pharmaceutical advertising to physicians and consumers that must be in compliance with FDA guidelines for Direct to Physician (DTP) and Direct to Consumer (DTC) advertising and promotion. The PTN will not monitor compliance with applicable laws and regulations. However, PTN reserves the right to review all advertising for compliance with applicable laws and regulations and, if the PTN becomes aware of any breach or potential breach of any applicable law or regulation or of these guidelines, PTN may remove the advertising. The Pull-Thru Network Will Only Share Aggregate Member Information The PTN may share aggregated, anonymous statistical information regarding the membership of the PTN with our advertisers and sponsors. Information in these aggregate summary reports cannot be linked to our members individually. At no time will the PTN share our mailing list with any of our advertisers or sponsors. Updating This Policy This advertising policy may be revised periodically. When we make a significant change that affects our advertising policies and practices the PTN will post a notice in The PTN News prior to that policy taking effect.

4 Pull-thru Network, Inc Wintergreen Parkway Normal, IL Pull-thru Network Advertising Contract The Pull-thru Network News (PTN News) Deadlines Hollie Filce, Editor or Publication Date Advertising Contract Due Advertising Materials Due January December 10 December 15 May April 10 April 15 September August 10 August 15 Publication dates are the approximate dates that Pull-thru Network makes every attempt to publish and distribute the issue to members. However, Pull-thru Network reserves the right to publish and distribute any issue at a date later than the ones stated above. Regardless of the publication dates there will be three (3) issues published each calendar year. Terms and Conditions 1. The Pull-thru Network News reserves the right to refuse any advertising on the basis of ethical or professional considerations. 2. All advertisements are accepted and published by Pull-thru Network on the representation that the advertiser is properly authorized to publish the entire contents and subject matter thereof. It is understood that in consideration of the publication of advertisements, the advertiser will hold Pull-thru Network harmless from and against any suits for libel, violation of privacy, plagiarism, copyright infringement, liability for use of classified material and any other claims based on the contents or subject matter of such advertisements. 3. No conditions other than those set forth in this rate card and contract shall be binding on Pull-thru Network unless specifically agreed to in writing by Pull-thru Network. Pull-thru Network will not be bound by conditions printed or appearing on order blanks or copy instructions which conflict with the provisions of this rate card and contract. 4. The Pull-thru Network News is not responsible for errors in advertisements submitted or for losses to the advertiser due to those errors. It is the responsibility of the advertiser to ensure the accuracy of materials submitted for publication. In the event of an error on the part of The Pull-thru Network News, the advertiser must inform the Editor in writing within ten days of publication. The only liability for which The Pull-thru Network News will assume responsibility is the cost of the space needed to run the corrected advertisement in future issues. This cannot exceed the cost of the original ad space. 5. Any preparation costs needed in readying copy are the responsibility of the advertiser. 6. Any advertiser wishing to cancel an advertisement must notify The Pull-thru Network News in writing by the contract due date of the issue. Changes in insertion orders or cancellations will not be accepted by the publisher after that date. If the advertiser should fail to provide prepared copy by the deadline, he or she will still be charged for the contracted advertising space at the regular rate. No refunds for cancelled advertisements will be provided. 7. The Pull-thru Network News makes no guarantee, express or implied, regarding the timing of its production or distribution. The Pull-thru Network News disclaims any responsibility for any and all losses, direct and indirect to advertisers occasioned by delays in publication, whether or not resulting from circumstances beyond the control of The Pull-thru Network News. 8. Payment is due upon receipt of the advertising contract. 9. This contract is not transferable. 10. Insertion dates on contracts must specify exact dates on ad insertions unless an agreement is worked out with the editor. To change insertion date, advertiser must notify the Editor in writing by closing date of issue. 11. Return of artwork must be specifically requested by advertiser at time or insertion. Artwork will not be returned. 12. All payments are due with the submission of the advertising contract to Pull-thru Network. Pull-thru Network assumes no liability if, for any reason, it becomes necessary to omit an advertisement. 13. Both the advertiser/sponsor and/or the authorized signer agree that they shall be held legally responsible under the terms specified herein. 14. This form becomes a contract when accepted by The Pull-thru Network. All standard advertisements are contracted to be inserted in three (3) issues of the Pull-thru Network News. Consideration will be given to the insertion of one-time, full page advertisements. Contact the editor of The Pull-thru Network News for space availability and a rate quote. Rates Artwork Information Ad. Size Institutional Member Ad. Only Full page Membership fee + $600 $1000 All advertisements should be submitted electronically, either via e- ½ page Membership fee +$200 $600 mail or CD-ROM, for high-resolution reproduction in black and ¼ page Included with $500 $400 white. JPG files preferred, but PDF files will be accepted. It is the membership fee advertiser s responsibility to ensure the resolution of the artwork Rates listed above are for 1 year/3 issues. Contact the editor submitted is sufficient for the size of the advertising space bought. for single edition advertising availability and pricing. We suggest the use of a return receipt to confirm the receipt of any files sent by . Materials will not be returned. Please retain this page for your records. The next page must be submitted to the Pull-Thru Network with your advertisement. You may scan and submit this form via or mail to the address listed above.

5 Pull-thru Network, Inc Wintergreen Parkway Normal, IL Pull-thru Network Advertising Contract The Pull-thru Network News (PTN News) Deadlines Hollie Filce, Editor or Company: Contact Person: : City: State: Zip: Full page, 3 issues One-half page, 3 issues One-fourth page, 3 issues Insertion Information Please enter preferred start date (month/year): Advertisement to be placed in three (3) consecutive issues. Fax: Payment Information Date Submitted: Amount Paid: Check Number: Payment is due upon receipt of the contract, made payable to Pull-thru Network, Inc. Payments may also be made online using PayPal (PullThruNetwork@gmail.com) Terms and Conditions

6 1. The Pull-thru Network News reserves the right to refuse any advertising on the basis of ethical or professional considerations. 2. All advertisements are accepted and published by Pull-thru Network on the representation that the advertiser is properly authorized to publish the entire contents and subject matter thereof. It is understood that in consideration of the publication of advertisements, the advertiser will hold Pull-thru Network harmless from and against any suits for libel, violation of privacy, plagiarism, copyright infringement, liability for use of classified material and any other claims based on the contents or subject matter of such advertisements. 3. No conditions other than those set forth in this rate card and contract shall be binding on Pull-thru Network unless specifically agreed to in writing by Pull-thru Network. Pullthru Network will not be bound by conditions printed or appearing on order blanks or copy instructions which conflict with the provisions of this rate card and contract. 4. The Pull-thru Network News is not responsible for errors in advertisements submitted or for losses to the advertiser due to those errors. It is the responsibility of the advertiser to ensure the accuracy of materials submitted for publication. In the event of an error on the part of The Pull-thru Network News, the advertiser must inform the Editor in writing within ten days of publication. The only liability for which The Pull-thru Network News will assume responsibility is the cost of the space needed to run the corrected advertisement in future issues. This cannot exceed the cost of the original ad space. 5. Any preparation costs needed in readying copy are the responsibility of the advertiser. 6. Any advertiser wishing to cancel an advertisement must notify The Pull-thru Network News in writing by the contract due date of the issue. Changes in insertion orders or cancellations will not be accepted by the publisher after that date. If the advertiser should fail to provide prepared copy by the deadline, he or she will still be charged for the contracted advertising space at the regular rate. No refunds for cancelled advertisements will be provided. 7. The Pull-thru Network News makes no guarantee, express or implied, regarding the timing of its production or distribution. The Pull-thru Network News disclaims any responsibility for any and all losses, direct and indirect to advertisers occasioned by delays in publication, whether or not resulting from circumstances beyond the control of The Pull-thru Network News. 8. Payment is due upon receipt of the advertising contract. 9. This contract is not transferable. 10. Insertion dates on contracts must specify exact dates on ad insertions unless an agreement is worked out with the editor. To change insertion date, advertiser must notify the Editor in writing by closing date of issue. 11. Return of artwork must be specifically requested by advertiser at time or insertion. Artwork will not be returned. 12. All payments are due with the submission of the advertising contract to Pull-thru Network. Pull-thru Network assumes no liability if, for any reason, it becomes necessary to omit an advertisement. 13. Both the advertiser/sponsor and/or the authorized signer agree that they shall be held legally responsible under the terms specified herein. 14. This form becomes a contract when accepted by The Pull-thru Network. Signature: Printed Name: Position: Date: Accepted by PTN News Editor (for office use only below this line): Signature: Date: Issue of First Advertisement: Issue of Last Advertisement: