Get Enclose Your Dues Payable To Acp (or Include Credit Card Information On The Application) And Return

This guide provides step-by-step instructions on how to accurately complete the Enclose Your Dues Payable To ACP (or Include Credit Card Information On The Application) And Return form online. Following these detailed instructions will ensure a smooth application process for prospective ACP members.

Follow the steps to successfully fill out the form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Complete the application information, including your full name, daytime phone, preferred email address, and mailing address. Ensure all information is accurately entered.
3. Indicate any other surnames used professionally, which may assist in verifying your application.
4. Provide your National Provider Identifier (NPI) number, if you have one, and medical education details, including your medical school, graduation year, and degree earned.
5. Fill out your current position, specialty, training start and end dates, and provide details about your current training program.
6. Affirm your eligibility by indicating if you have ever been subject to disciplinary action. If applicable, provide a detailed explanation.
7. For payment, check the relevant box to enclose your dues payable to ACP or indicate that you will include credit card information on the application.
8. If paying by credit card, complete the credit card information section, including card number, expiration date, and security code.
9. Sign and date the application to confirm that the information provided is true and complete.
10. Review the completed form for accuracy and save your changes. You can download, print, or securely share the form as needed.

Complete your application online today to secure your ACP membership benefits.