Membership - Membership Application

We welcome new members to join us as an integral part of the podiatric sports medicine community. Just complete the online form below to begin the member application process.

If you would like a membership application mailed to you, please request it either by telephone 301-370-2397 or email: ritayates2@aol.com.

* Required Fields

Name*:
Member Type*:	AAPSM Associate Member AAPSM Affiliate Member** Resident Member Student Member
** Shall have a degree from an accredited college or university, internationally, in a health related field, (example here would be C.Ped, DC) and a member in good standing of their respective national organization and licensed by their respective state.
Please check if you are board certified through:	ABPM ABMSP ABFAS
Main Office Address*: (Address will display on website)
City/State*:
Zip Code*:
Phone*:
Fax:
E-Mail Address*:

Education: Please list in chronological order all undergraduate, graduate, professional and postdoctoral institutions attended.

Institution*:
City/State*:
Degree or Certification*:
Year Graduated*:

Institution:
City/State:
Degree or Certification:
Year Graduated:

Institution:
City/State:
Degree or Certification:
Year Graduated:

Professional Licenses: Please list professional licenses, or certifications or registration which you hold:

License/Certification*:
State/Organization*:
Date Issued*:

Associate/Affiliate Membership: Candidate Shall:

Have earned a degree from an accredited college or university in the United States in a health related field.
Be a member in good standing of their respective national organization-APMA if a podiatrist
APMA Membership Number*:
Be licensed by their respective state

Membership - Membership Application

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