Follow the steps to successfully complete your application

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering your personal information at the top of the form. This includes your first name, middle initial, and last name. Make sure to include your degree(s) as well.
3. Provide your business address, including the institution name, department, and room/suite number. Fill in the city, state, zip code, and country appropriately.
4. Next, complete your home address details, providing the street address, city, state, zip code, and country.
5. Enter your contact information, including your business phone, home phone, mobile phone, fax, and email addresses. Clearly indicate your primary email address, as it will be used for important communications.
6. In the personal and professional information section, provide your date of birth, gender, and whether you identify as part of a gender or sexual minority. Additionally, consent to store and process your ethnicity information by selecting 'Yes' or 'No.'
7. Indicate your ethnicity by checking all that apply. This helps AAPM&R in promoting diversity within its membership.
8. Specify your primary language spoken and enter details about your academic and medical degrees, including the institution and date conferred.
9. Fill in your PM&R residency institution and graduation date along with your state of licensure, NPI number, and opioid prescriber number.
10. Select your membership type by confirming your status as a Fellow in the Academy. Enter your ABPMR and AOBPMR certificate numbers if applicable.
11. Engage with member communities by selecting your areas of interest that facilitate networking and growth.
12. Indicate how you heard about AAPM&R to assist in evaluation of outreach efforts.
13. Read and acknowledge the application signature section, agreeing to support AAPM&R bylaws. Sign and date the application.
14. In the payment information section, complete your payment method, including credit card information if applicable. Ensure you provide necessary details to avoid delays.
15. After reviewing all information for accuracy, save changes, and proceed to either download, print, or share the completed form for submission.

Start your AAPM&R Membership Application online today to take the first step towards becoming a member.