Senior 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 licensed DPM who is a member in good standing of this association and in good standing of an available component may apply for classification as a Senior Member if said member: Has attained the age of 65 years; AND Is not actively engaged in practice for more than 20 hours per week; AND Has been in good standing for 20 consecutive years or for an aggregate of 25 years. Senior 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 election or appointment to any office, committee, council, board, 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?
	Phone Number
	Birth Date
	Number of Hours in Practice Per Week
		Maximum of 20 hours per week.
	Effective Date of Change to Senior Status

	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 Senior Member status as long as I continue to qualify under the bylaws of the Association. If the amount of my practice hours increases beyond the maximum of 20 hours per week, I understand that I am no longer a Senior member and will revert back to Active status.
	Today's Date
		Month, Day, Year