Trainee Membership (Fellow) Application

AAPM Trainee Membership is open to physicians enrolled and in good standing in a fellowship program at an institution within the United States of America that is approved by the Accreditation Council on Graduate Medical Education or the American Osteopathic Association. Requires a letter from the fellowship program director or coordinator verifying enrollment in good standing. This category is for the one-year fellowship and then at renewal, your membership becomes Active Membership with the renewal fees of an Active Member. Your Membership includes:

1. AAPM's Journal Pain Medicine - the premier source of peer-reviewed research and commentary on the multidisciplinary clinical practice of pain medicine.

2. AAPM E-News - stay informed with AAPM's bimonthly e-newsletter that provides timely updates on the latest developments in pain research, advocacy, practice management, clinical trials and news about Academy members.

3. Premier pain education - discounted registration rates for the AAPM Annual Meeting.

4. AAPM Education Center Waived or Reduced Fees on quality, on-demand education presented by top pain experts.

5. Practice Management Tools - stay up-to-date on current events impacting your daily practice with cinical practice guidelines and coding tips.

6. Shared Interest Group (SIG) opportunities to network, advance shared practice interests, or promote discussion in a particular discilpline or topic.

* First Name:

* Last Name:

Email Address:

Job Title:

Gender

* Organization :

* Date Of Birth

Address Line 1:

Address Line 2:

Address Line 3:

City:

Country:

State:

Postal/Zip Code:

Telephone 1:

Telephone 2:

Cell:

Fax:

* Address Line 1:

Address Line 2:

* City:

* Country:

* Postal/Zip Code:

International State/Province:

* Telephone 1:

Telephone 2:

Cell:

Fax:

Instagram:

Facebook:

Twitter:

LinkedIn:

{FIRST_NAME}	Adds the recipients First Name.	Use
{LAST_NAME}	Adds the recipients Last Name.	Use
{COMPANY_NAME}	Adds the Company Name.	Use
{PORTAL_NAME}	Adds the application portals name.	Use
{MEMBER_NAME}	Adds the Recipients Membership name.	Use
{SIGNATURE_OPT_IN}	Adds the Opt-in link.	Use
{SIGNATURE_OPT_OUT}	Add the opt-out link.	Use
%signature%	Adds your preferred signature block.	Use
{Event_Start_Date}	Adds the Event's Start Date.(Events Only)	Use
{Event_End_Date}	Adds the Event's End Date.(Events Only)	Use
{Event_Name}	Adds the Event's Name.(Events Only)	Use
{Event_Description}	Adds the Event's Description.(Events Only)	Use
{Online_Training_Description}	Adds the Online Training Description.(Online Training Only)	Use
{Event_Specific_Dates}	Adds the Event's specific dates.(Events Only)	Use
{member_number}	Adds the Membership Number.	Use
{MemberSince}	Adds the Member Since Date.	Use
{CONTACTEMAIL}	Adds the Contact's Email Address.	Use
{EVENT_CREDITS}	Adds the Event's Credits.(Events Only)	Use
{CERTIFICATE_NUMBER}	Adds the Contact's Certificate Number	Use
{EVENTLOCATION}	Adds the Event's Location.	Use
{TOTALEVENTCREDITS}	The total number of credits that the contact has earned through the event tickets.	Use
{ASAPPEARSONBADGE}	Display the text of as appears field in the event setup.	Use
{contact_organization}	Displays the organization name of the contact.	Use
{RENEWALDATE}	Adds the Member Renewal Date in (yyyy-mm-dd).	Use
{MEMBERSHIP_YEAR}	Adds the Member's Membership Year	Use
{RENEWALDATE_MM-DD-YYYY}	Adds the Member Renewal Date in (mm-dd-yyyy).	Use
{LMS_CREDIT}	The number of credits the LMS course is worth for Continuing Education	Use
{COLLECTION_PERIOD_END-DATE_YYYY_MM_DD}	The end date of the CE collection period end date	Use
{LMS_COURSE_COMPLETION_DATE}	The completion date of the LMS course	Use
{INCEPTION_DATE}	Adds the Member Inception Date in (yyyy-mm-dd).	Use
{EVENT_END-DATE_MONTH_YYYY}	Adds Event End Date in Full Month Name and Year Format.(Events Only)	Use
{EVENT_END-DATE_MONTH_YYYY_ADD3}	Adds Event End Date in Full Month Name and Year Format Plus 3 Years.(Events Only)	Use

Trainee Membership (Fellow) Application

Contact Information

Secondary Contact

Member Photograph