AAGP Membership Application

Have an account? Click here to log in...

Founded in 1978, the AAGP provides psychiatrists and 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 (Board approval of new membership takes 3-4 weeks).

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

Membership Level:

Psychiatrist Member - $345

Non-Psychiatrist Member - $295

Retired Member - $180

Member-In-Training - $50

Student - $50

HI/UMI-Psychiatrist Member - $345

LMI-Psychiatrist Member - $155

HI/UMI-Non-Psychiatrist - $295

Check this box to automatically renew your membership annually.

Prefix: First Name: Middle/Initial: Last Name: Suffix: Degree: Primary Email: Secondary Email: Primary Phone#: Secondary Phone#: Birth Date: / / Gender: Which of the following best describes your racial or ethnic identification? Prefer to self-describe your racial or ethnic identification: Language Language - If Selected Other Mailing Street Address: City: State: Zip: - Country: Company: Job Title: Please confirm your profession: Work Setting (Check all that apply) Are you:

Early Career Psychiatrist (First 7 years since training)

International Medical Graduate

I am both IMG and ECP

Not Applicable

Describe how your work relates to mental health Percentage of work with the elderly Board Certified

Yes

Please specify Board certifications you have received Do you accept Referrals Professional Membership(s) held How did you hear about AAGP? Referred Name and Email:

Please create a user id and password below for our system to manage your AAGP account (i.e., view donation history, renew membership, etc.). Your password must be at least eight characters long, and contain at least one number.