Life Member Application

Advocating for Podiatrists and their Patients

Practicing DPMs
Students & Residents
Patients & the Public
Advocacy

Per the bylaws approved by the APMA House of Delegates in March 2019, a member in good standing of this association and in good standing of an available component may apply for classification as a Life Member if said member: Has completely retired and remains retired from the practice of podiatric medicine, attained the age of 65 years, AND either been a member in good standing for 20 consecutive years or for an aggregate of 30 years; OR A licensed DPM member who has been in good standing for a minimum of 50 years (aggregate). Life Members shall be eligible: To receive all official communications of the association. For admission to any educational session and such other services as are provided by the association. For appointment to any committee or similar position in the association as provided in these bylaws.

	First Name
	Middle Name
	Last Name
	Previous Last Name
		(changed due to marriage, divorce, etc.)
	Email Address
		(the email address currently used by APMA to stay in touch with you)
	Preferred Mailing Address
	City
	State
	Zip
	Is this your Home or Office Address?
	Do you have a seasonal home?
		If you reside in more than one location throughout the year, please provide us with the additional mailing address and dates, if possible.
	Phone Number
	Birth Date
	Retirement Date

	Signature
		By entering my name above, I hereby affirm that I am in accordance with the above stated APMA Bylaws and that the information contained in this application is true to the best of my knowledge. I understand that if approved, I may maintain my Life Member status as long as I continue to qualify under the bylaws of the Association.
	Today's Date
		Month, Day, Year