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https://aaap.org/membership/applicationsecure.htm

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click on the address above.

AAAP Membership Application

 

*For New Applicants ONLY*

 

If you are a current AAAP Member looking to renew your dues online, please visit https://aaap.org/renewal/duesnoticesecure.htm. 

 

 
Part I. Personal Information
  Please list your mailing address below.
 

Is the mailing address listed below your home or work address?

                     Home                         Work
Title:
First Name:
Last Name:
Middle Initial:
Degrees:
Organization/
Company:
Address 1:
Address 2:
City:
State:
Zip/Postal Code:
Country:
Work Phone:
Fax:
Home Phone:
E-mail:
Date of Birth:
Sex:
Citizenship:
 

What address do you prefer we send mail to ?   Home                       Work

If that address is not listed above, please list below:

 

Part II.

Education and Affiliations
Years in Practice:

*   *   *   *   *
Board Certification: (If applicable) Please include name of subspecialty board and date.

*   *   *   *   *

Do you have ABPN Subspecialty Certification in Addiction Psychiatry? 

      Yes     No    

      Date Received   

*   *   *   *   *

American Psychiatric Association Membership Status: 

      General Member       Fellow      Life Fellow

      Student Member       Non-Member

*   *   *   *   
References: List two members from either AAAP or APA. Please include name, affiliation and phone number. 

 

*   *   *   *   *
Periodically we have various organizations or journals request our mailing list. 

        Do you wish to have your address given to requestors?  Yes    No

*   *   *   *   *

AAAP Patient Referral Program – When you participate in the AAAP Patient Referral Program, patients who are seeking treatment in your area will be able to find your contact information easily.

 

Would you like to participate in the AAAP Patient Referral Program? 

Yes    No      

*   *   *   *   *

   By checking this box, I agree to abide by the Charter and Bylaws of the American Academy of Addiction Psychiatry. I understand that the organization will review my application and my references.  I will hold the Academy, its' members, examiners, officers, employees and agents free from all damage and complaint by reason of any action taken on this application or by reason of any subsequent action on membership. I pledge myself to high standards of ethical practice.  Being a member of the Academy DOES NOT, at any time or by any means, make me a representative of the organization nor give me the right to speak on its' behalf.  

*   *   *   *   *
Part III. Annual Dues: Please check your payment option.

Term

Rate

Rate

Rate

Rate

Rate

Rate
 

Regular/

Affiliate Members

 

Retired Members

 

Residents

 

 

Medical Students

Physicians 1-3 Years out of Residency

International 

(NON US/ Canada)

1 Year

 
$215.00

 
$123.00

 
$60.00

 
$50.00

        

$100.00

 
$205.00

3 Year

 
$600.00

 N/A

N/A

N/A

N/A

 
$570.00 

Billing Information

  
                                      Click here if billing information is the same as shipping information (at the top).
Billing First Name:
Billing Last Name:
Billing Address1:
Billing Address2:
Billing City:
Billing State:
Billing Zip:
Billing Country:
 
Part VI. Payment
Card Number:
Expiration Date:
CSV Code:

    On the back of your credit card, you should see three digits that are not part of your credit card number. These three digits are your Card Security Verification (CSV) number.