Educational Membership

Educational Membership Registration. (One Year)

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$0 USD / One Time (for 1 year access, non-recurring)

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First Name *

Last Name *

Email Address *

Username (lowercase alphanumeric) *

Password (type this twice please) *

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Additional Info

Membership Level *

Personal Information

Current Institution *

Practicing Status *

Degree *
MD PhD DO Other

PGY Level (Select NA if not in training) *

Optional Personal Information

Name in Chinese

Middle Name

Job Title

Years After Training
0-5 5-10 10-15 More than 15

Business Address

Phone

Practice Type
Private Practice Academic Retired

Subspecialty (Use Ctrl + Click to select multiple)

Medical School

Interests in Administrative Roles
Executive Committee Education Committee Membership/Website Committee Finance Committee Award Committee Newsletter Committee Private Practice Committee Career Development Committee

Autobiography

By checking this box, I confirm that the information I provided is accurate and complete to the best of my knowledge. I confirm that I am qualified for the type of CAPA membership I am applying. I agree to be bound by terms and conditions of CAPA membership and abide by all the pertinent rules set by CAPA bylaws. * By checking this box, I confirm that the information I provided is accurate and complete to the best of my knowledge. I confirm that I am qualified for the type of CAPA membership I am applying. I agree to be bound by terms and conditions of CAPA membership and abide by all the pertinent rules set by CAPA bylaws.

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