Student Membership Application
Bylaws:
1. Students applying for student membership must be enrolled in a medical or osteopathic school approved by an appropriate United States accrediting institution as defined by the Academy's Commission on Education.
2. Do not send dues — you will be billed.
3. One-time national dues are $15.00 for membership throughout your medical school career. Chapter (state) dues are charged in some states, and some chapters pay all or part of student dues.
4. I hereby agree to abide by the Constitution and Bylaws of the American Academy of Family Physicians and the bylaws of my constituent chapter.
5. Membership terminates upon graduation. If you desire to maintain AAFP membership, you must reapply for resident status.
6. I authorize my medical school to provide my current address to the AAFP and the constituent chapter in order to maintain membership records.
Completely fill out the information below. Please allow 4-6 weeks processing time before you begin receiving the journal.
Full Name:

First
Middle
Last
Former Name:

First
Middle
Last
Gender: Male Female
Date of Birth:

Month
Day
Year
Mailing Address:

Address 1

Address 2

City
State

Zip/Postal Code 		 
Telephone Number:
Fax Number:
Email Address:
Medical School:

School

City
State
Graduation Date:

Month
Year
Submission of this application constitutes agreement to abide by the Constitution and Bylaws of the American Academy of Family Physicians and the bylaws of my constituent (state) chapter.