Non-psychiatrist Membership Application

 

 

*Returning Members: If you have previously been a member of AAGP within the last four years, please use the Renew form. Board approval of new membership takes 3-4 weeks.

AAGP Membership Application for Non-Psychiatrists

Founded in 1978, the AAGP provides psychiatrists and other health care professionals with a special interest in mental health care of the elderly exceptional professional benefits through educational, informational, and interactive programs. This application will be reviewed and voted upon by the AAGP Board of Directors.

 

AAGP membership is based on the calendar year (January - December) and ends on December 31 of each year.

 

Eligibility

1. The applicant must have an advanced degree (masters level or higher); and
2. The applicant must meet ONE OR MORE of the following criteria:
2a. have an active research grant (as principal or co-investigator) in an area related to geriatric mental health;
2b. have attended the Summer Research Institute;
2c. spend at least 50% of his or her time in clinical practice (e.g., psychology, neuropsychology, internal or family medicine, neurology, nursing, or another discipline), teaching, or administration devoted to geriatrics.

*Notes: All prospective members (non-psychiatrist and psychiatrist members) are required to complete an application and will be accepted provided they meet the above criteria. Graduate students and post-doctoral fellows may join at trainee rates as indicated below.

 

Rights and Benefits
Members are voting members of the Association as legally defined in its bylaws, and:

1. receive all standard member benefits (e.g., subscriptions, member discounts);
2. may serve as a director but not officer on the AAGP Board of Directors; and
3. participate for a reduced annual membership fee (see www.aagpmeeting.org).


2018 Annual Dues
Member: $295
Member-in-Training for Residents & Fellows: $50 (Post-doctoral fellows within first five years of fellowship)
Medical and Graduates Students: $25 (no Journal access)
Medical and Graduates Students: $50 (includes online only access to Journal)

2018 International Member Annual Dues
Dues are based on World Bank resident country income group category:
HI and UMI resident country: $295
LMI Resident Country: $135
LI Resident Country: $85

AAGP dues are not deductible as a charitable contribution for tax purposes. However, they may be deductible as a business expense subject to restrictions imposed as a result of association lobbying activities. AAGP estimates the nondeductible portion of your dues to be 29%.


General Information  

 
First Name
Middle Name
Last Name
Degree(s)
Institution/Organization/Company
Job Title
 
The following address is my
 
Mailing Address
Mailing Address Line 2
City
State
Zip
Country
 
Email
Work Phone
Home Phone
Cell Phone
Other Phone
Fax
 

AAGP needs your written consent to fax any AAGP product or service correspondence to you. If you agree to this consent, AAGP will not sell your fax number to third parties. Please note that you can revoke this consent at any time by alerting AAGP in writing.

I provide consent to AAGP

 
Membership Directory

Your address as you want it posted on the Member Directory if different than above.

Address
Address 2
City
State
Zip
Country
 

Education Background
 
Degree
Area of Study
Year
Institution
City
State
Country
 
Post graduate/Fellowship training
Year
 
Are you a graduate of the AAGP/NIMH Summer Research Institute?
 Yes
 No
Year(s)
 

Professional Background
 
Professional Licence(s) held
Professional Membership(s) held
 
Please describe how your work relates to mental health and aging, including the percentage of your work week dedicated to this function.
 
Do you have any research grant(s) related to geriatric psychiatry for which you are a principal or co-investigator?
 yes
 no
Grant Title
Funding Source
Principal Investigator(s)

Demographics (optional)
Filling out this section is optional; however, information provided by potential members enables AAGP to respond to inquiries primarily from our members about diversity in the field and membership.
 
Ethnicity
Primary Language spoken
Gender

References
Please list the names and phone numbers of two professional references that AAGP may contact who are familiar with your work related to geriatric mental health. AAGP members are preferred.
 
Reference Name
Degree
Phone
Title
Affiliation
 
Reference Name
Degree
Phone
Title
Affiliation
 

Membership Information
 
How did you initially hear about AAGP?
If an AAGP member referred you to AAGP,
please list his/her name
Other, please specify
 
Have you ever attended the AAGP Annual Meeting?
If Yes, please specify year(s)
 
Check here if you agree with the following statement: I affirm that all information provided is correct to the best of my knowledge.
 All info is correct
 
Type your name to serve as your signature
 
Any other information we need to know that did not fit on the application?
 

Membership Type
 
Select Membership Type

Login Information
Please create a user id and password below for our system. AAGP will activate your log-in account and send you an email. Once you receive the email you will be able to log in and access member-only pages and forms (for example, the Annual Meeting registration with member rates). AAGP will activate your log-in account within 2-3 business days and send you an email.
 
User ID
Password