Get Aapm&r Membership Application 2019-2026

Filling out the AAPM&R Membership Application online is a straightforward process designed for first-time members. This guide provides clear, step-by-step instructions to help you complete the application accurately and efficiently.

Follow the steps to successfully submit your membership application.

1. Click the ‘Get Form’ button to access the application form and open it in your editing tool.
2. Begin by entering your first name and last name as printed on official documents. Ensure that all required fields are completed accurately.
3. You may provide your middle initial and title along with your degrees.
4. Input your business address. This address will be used for the Member Directory. Make sure to fill in the street, city, state, and zip code correctly.
5. Also, include your preferred billing address if different from your business address.
6. Provide your home address, including street, city, state, and zip code. Indicate if this differs from your business address.
7. Fill in your contact details, including business and home telephone numbers, fax number, and both business and home email addresses. Ensure that you identify your primary email address, as all communications will be sent here.
8. In the personal and professional information section, enter your date of birth, confirm your U.S. citizenship status, and select your gender.
9. If comfortable, indicate if you consent to AAPM&R storing your ethnicity information.
10. List your academic and medical degrees, including the institutions, dates conferred, and any relevant residency or licensure details.
11. Select your membership type, confirming your board certification status and providing necessary certificate numbers.
12. Include your NPI Number and opioid prescriber number if required.
13. For the member communities section, choose the communities you wish to join based on your interests and specialties.
14. Indicate how you heard about the Academy and provide your signature along with the date to complete your application.
15. Choose your payment method, supplying the necessary credit card details or check information. Ensure that all payment information is accurate.
16. Finally, review your application for accuracy. You can then save changes, print, or share the form as needed.

Complete your application online today and become a member of AAPM&R!