AAPI

Membership Renewal

First Name*

Middle Initial

LastName *

Contact Information

Address 1*

Address 2

City *

State*

Zip Code *

Phone *

Personal Email *

AAPI Annual Membership Fee (AAPI Members ONLY - Check the appropriate box if you are paying Membership Fee )

Physicians in Practice(Couple):$100.00:

Spouse Name: ( Please Enter Spouse Name for Physicians Couple

Physicians in Practice(Single):$75.00:

Resident/Fellow in training (Couple):$50.00

Spouse Name: ( Please Enter Spouse Name for Resident/Fellow

Resident/Fellow in training (Single):$25.00

Total Amount *: $

Clicking below will take you to the secure PayPal website. You have the option to pay the fees through PayPal account or using a Debit or Credit Card. If you do not have a PayPal account, on the next page choose 'Donate with a Debit or Credit Card' and enter your details.