American Academy of Nephrology PA's
(AANPA)
Membership Application
Name: __________________________________________________
Home Address: __________________________________________________
__________________________________________________
E-mail: __________________________________________________
Work Address: __________________________________________________
__________________________________________________
Preferred Mailing Address: _________________________________
Are you a member of AAPA? __________
May we list you in AANPA member directory? __________
Employment setting:
Private practice___, dialysis unit___, medical center___, academic___, VA facility___, federal services___, administration___, other____________________________What are your interests in AANPA? __________________________________________________
__________________________________________________
Dues:
FELLOW: (certified or eligible) ------ $20.00
STUDENT: -------------------------------- $ 0Return to:
Molly Lenahan
1812 Shady Grove Lane
Fleming Island FL 32003