Name (first/middle/last):
Birth Year:

AAP-CA2 Categories of Chapter Membership
Chapter Affiliate -- Dues: $165
Voting Fellow -- Dues: $165
Candidate Fellow -- Dues: $120
Retired Fellow (from active practice) -- Dues: $75
Emeritus Fellow -- Dues: $50
Post Resident Fellow -- Dues: $0
Resident -- Dues: $0
Your listing for the Directory of Members: Please make listing exactly as you want it published.
Mailing Address:
City: State: Zipcode:
Phone: Fax: Email:
Specialty: Board Certified Board Eligible
Subspecialty: Board Certified Board Eligible
Academic History (Affiliate Member only)
Medical School:
Graduation Year:
Internship:
Year:
Residences:
Year:
Postgraduate work:
Hospital Staff:
Percentage of professional time devoted to pediatrics: