Resident / Postgraduate Membership Application

Thank you for your interest in APMA! We look forward to being of service. APMA membership is FREE for residents and other DPMs in training. Please complete this form to begin the membership activation process.

CONTACT INFORMATION
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    (changed due to marriage, divorce, etc.)
 
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    Month, Day, Year (For statistical purposes only.)
 
    For statistical purposes only.
 
    For statistical purposes only.
EDUCATION
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    Note "N/A" if Unplaced Graduate
 
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    (PMS36, etc. Note "N/A" if Unplaced Graduate)
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    Month and Year
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    Month and Year (cannot equal current year)
 
AGREEMENT
   
  Those serving in a V.A. or military hospital or other federally sponsored institution will be enrolled in the Federal Service component (FSPMA). You may opt out of FSPMA membership and, instead, be enrolled in the state component association in which your program is based by checking the box above.
Required  
  By checking the box above, I agree that upon my membership being confirmed, I will abide by the bylaws, code of ethics, and all rules and regulations set forth by the component association and APMA. Dual component and national (APMA) membership is required. Completion of this form satisfies application requirements for both the component association and APMA. No person otherwise qualified for membership shall be denied such membership for reasons of age, sex, color, race, creed, national origin, sexual orientation, political belief, or disability.
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    Month, Day, Year
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PROFESSIONAL LICENSURE
 
 
 

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