AAGP Membership

AAGP Membership

Complete the form below to join the American Academy of General Physicians. Fields marked with * are required.

Price:

$1,400 for 1 Year

First Name:* First Name Required

Last Name:* Last Name Required

Address Line 1:* Address Line 1 is Required

Address Line 2: Address Line 2 is not valid

City:* City is Required

Country:* Country is Required

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State/Province:* State/Province is Required

Zip/Postal Code:* Zip/Postal Code is Required

Birthdate:* Birthdate is Required

Phone Number:* Phone Number is Required

List Degrees and Instituions:* List Degrees and Instituions is Required

Years in Practice:* Years in Practice is Required

Name of Current Practice:* Name of Current Practice is Required

Practice Street Address:* Practice Street Address is Required

Practice City:* Practice City is Required

Practice State:* Practice State is Required

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnestoaMississippiMIssouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginaWashingtonWest VirginiaWisconsinWyomingDistrict of Columbia

Practice Zip:* Practice Zip is Required

State of Licensure:* State of Licensure is Required

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingDistrict of Columbia

License Number:* License Number is Required

License Status:* License Status is Required

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Password:* Invalid Password

Password Confirmation:* Password Confirmation Doesn't Match

Password Strength

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Credit Card

I have read and agree to the Membership Terms*

 

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