Membership Renewal Form

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Our member categories have changed! Please review the categories to the right to ensure the correct option below is selected.

Current International Members should select 2023 Professional Membership. Current Student Members who are residents or fellows should select 2023 Early Career Membership.

Membership dues pricing is for the 2023 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.

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.

Proof of Student Status *

Examples of acceptable documentation include letter from department chair or a transcript.

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Special Interest Groups

22q11.2 Related Disorders SIG

Care Coordination SIG

Ethics SIG

Feeding Nutrition and Growth SIG

Global Care SIG

Mental Health/Psychosocial 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 in your membership registration

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 a submember

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$ Add a donation

Other Amount

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USD

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Donation

Discount Code

Code:

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Order summary

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Discounts -{{formatAmount(orderSummary.discounts)}}

Total {{formatAmount(orderSummary.total)}}

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Card

or enter your card details below

Cardholder First Name *

Cardholder Last Name *

Cardholder Email

Card *

Billing address is the same as mailing address

Address Line 1

Address Line 2

City

State/Province

Zip *

Country

Amount:

{{formatAmount(totalAmount)}} USD

({{formatAmount(amexTotalAmount)}} USD for AMEX cards)

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ACPA Membership

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

	Contact Name	Membership Level
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No contacts.