Resident / Postgraduate Membership Application

Thank you for your interest in APMA! We look forward to being of service. Please complete this form to begin the membership activation process.

CONTACT INFORMATION
Required
 
Required
 
    (changed due to marriage, divorce, etc.)
 
Required
 
Required
Required
Required
 
Required
Required
 
    Month, Day, Year (For statistical purposes, only.)
 
    For statistical purposes, only.
 
    For statistical purposes, only.
EDUCATION
Required
Required
Required
Required
    Note "N/A" if Unplaced Graduate
 
Required
Required
 
 
 
Required
    (PMS36, etc. Note "N/A" if Unplaced Graduate)
Required
    Month and Year
Required
    Month and Year (cannot equal current year)
AGREEMENT
   
  Those serving in a V.A. or 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.
Required
    Month, Day, Year
 

Required = required information