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 Psychiatrists

Founded in 1978, the AAGP provides psychiatrists 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.

All members should follow the AMA's Principles of Medical Ethics.

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

 

Psychiatrist Member Criteria

1. The applicant must have completed a residency in psychiatry approved by the AMA-ACGME or be certified by the American Board of Psychiatry and Neurology in psychiatry.
2. The applicant must have been or must be actively engaged in the practice of geriatric psychiatry.
3. The applicant must have a major professional interest in the mental health care of the elderly, or devote substantial professional time in connection with public mental health or mental health care delivery systems for the elderly.

*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.

 

Member-in-Training Criteria
A physician who is enrolled in a residency in psychiatry or a fellowship in geriatric psychiatry that is affiliated with an accredited residency program. 


Retired Member Criteria
A psychiatrist who is (1) 65 years of age or older, (2) has been a Full Member for one year or more and (3) spends less than 15 hours/week in paid professional activities.


Student
Benefits include an online-only subscription to the association's journal, the American Journal of Geriatric Psychiatry. Regular student membership is $50 per year. Student membership without access to the journal is $25 per year.

 

2018 U.S. and Canada Annual Dues
Psychiatrist Member: $345

Retired: $180
Member-in-Training for Residents & Fellows: $50
Medical and Graduates Students: $50
Medical and Graduates Students (no access to AJGP): $25

2018 International Annual Dues
Dues are based on World Bank resident country income group catogories:

HI and UMI Resident Country: $345
LMI Resident Country: $155
LI Resident Country: $95

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

 

Prefix
First Name
Middle Name
Last Name
Suffix
Degree(s)
 
The following address is my
 
Mailing Address
Mailing Address Line 2
City
State (two letter postal abbrev., e.g. TX for Texas)
Zip
Country
 
Email
Work Phone
Home Phone
Cell Phone
Assistant 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/Foundation Find-A-Doctor List

Your address as you want it posted on the Member Directory if different from above. Members who accept referrals will also be listed publicly on the Geriatric Mental Health Foundation's website.

Address
Address 2
City
State
Zip
Country
 
Do you accept referrals?

Education
 
I am certified in psychiatry
I am certified in Geriatric Psychiatry
Residency Year
Medical Year
 
I received my medical degree at
Do you have a current medical license?
State/Country of License
 
Residency Training in Psychiatry Institution
City
State
Country
 
Geriatric Psychiatry Fellowship Institution
City
State
 
Have you ever had your medical license revoked in any jurisdiction
 Yes
 No
If yes, where?
What year?
Please Explain

Professional Background
 
How did you initially hear about AAGP?
If an AAGP member referred you to AAGP, please list his/her name
 
Check organizations of which you are a member
 APA  IPA  CPA  AMA
 AGS  GSA  ACNP  AMDA
 
How would you describe yourself and your work?
What is your primary place of employment?
Other

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
Gender
Language spoken other than English

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 electronic 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