Membership Renewal Form

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Membership dues pricing is for the 2025 calendar year.

Please select any Special Interest Group (SIG) you would like to join.

The following information is for demographic purposes and will not be shared.

Include a submember in your membership registration

If you selected auto-renew, you membership will automatically renew on January 1 of each year.

Professional Membership (Join)

Affiliate Membership (Join)

Early Career Membership (Join)

Student Membership (Join)

Student Membership + CPCJ Supscription (Join)

Retired Membership (Join)

I would like my membership dues to automatically renew annually on January 1. (Do NOT select if you are a Student/Early Career Member.)

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First Name *

Middle Name

Last Name *

Prefix

Suffix

Designation (i.e. MD, PhD)

Phone

Address Line 1 *

Address Line 2

Address Line 3

City *

State/Province

Zip/Postal Code

Country *

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Primary Specialty *

Secondary Specialty

Institution/Company

Proof of Early Career Status *

Examples of acceptable documentation include (but are not limited to) verification letter from employer or department chair, or an offer letter. Documentation should include start and/or anticipated completion date.

Proof of Student Status *

Examples of acceptable documentation include letter from department chair or a transcript. Documentation should include anticipated completion date.

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Special Interest Groups

22q11.2 Related Disorders SIG

Care Coordination SIG

Feeding Nutrition and Growth SIG

Global Care SIG

Mental Health/Psychosocial SIG

Research Development SIG

Learn more about SIGs at https://acpa-cpf.org/special-interest-groups/.

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Birthday *

Gender *

Race/Ethnicity *

White or Caucasian

Hispanic or Latino

Black or African-American

Middle Eastern or Northern African

Asian - Eastern

Asian - Indian

Pacific Islander or Native Hawaiian

American Indian or Native Alaskan

Prefer Not to Say

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Include a submember

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Choose Existing Contact(s)

Membership Level *

I would like my membership dues to automatically renew annually on January 1. (Do NOT select if you are a Student/Early Career Member.)

First Name *

Last Name *

Add {{subMemberDisplayName}}

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Amount:

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ACPA Membership

Membership level allows for a maximum of {{term.subMemberAllowed}} submembers.

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