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AAEMI invites you to join as a member.

Faculty Registration will include:

  • Discounted and free registration to certain AAEMI conferences and endorsed events
  • 1 year subscription to the International Journal of Emergency Medicine (IJEM)
  • For life members it will include a 5 year subscription to IJEM

Personal Information*

*All information provided will be kept strictly confidential

First Name  
Last Name  
Home Address  
City  
State/Province  
Zip/Postal Code  
Country  
Hospital / Place of Work / Business Address  
City  
State/Province  
Zip/Postal Code  
Country  
Preferred Mailing Address Home Business
Date of Birth mm/dd/yyyy    
Graduation Date mm/dd/yyyy    

Residency Completion Date
mm/dd/yyyy

 
Occupation  
Business Phone  
Home Phone  
Fax
E-Mail  
Membership Dues:
Applicants from India/Sri Lanka
Membership Category (Check one box)
Physicians ($100 annually)
Residents ($50 annually)
Students/Other ($25 annually)
Life ($500)

Membership Dues: Applicants from Countries **other** than India/Sri Lanka

Membership Category (Check one box)
Physicians ($200 annually)
Residents ($100 annually)
Students/Other ($25 annually)
Life Membership ($1200)
   
Credit Card Type
Credit Card Number(without spaces)  
VPN (3 digit security number)  
Expiration Date (mm/yy)