Registration: IPAS Membership 2017-2018

We hope you will consider lending your support and talents to IPAS. Please complete the membership application and join a society that is continuously making strides to advance the PA profession.

Fellow (PA who is a member of the AAPA and works in Iowa)       $150
Affiliate (PA who is NOT an AAPA member and works in Iowa)       $150
Associate (Not working as a PA, or lives and works outside Iowa)       $50
Retiree (Retired PA who wants to stay current with the profession)       $50
Associate Nurse Practitioner (Advanced Registered NP)       $150
Supporter (Non-PA who receives newsletters and other information)       $150
Student (Currently enrolled in a CAAHEP-approved program)
 - valid throughout PA schooling and expires at the end of the normal membership year
      $25
Pre-PA Student       $25
Graduate (Available for students for their first year immediately after graduation)       $75
USER INFORMATION
First Name:
Last Name:
Home Address:
Home Address 2:
Home City:
Home State:
Home Zip:
Email:
Confirm Email:
Home Phone:
Work Address:
Work Address 2:
Work City:
Work State:
Work Zip:
Work Phone:
Work Fax:
AAPA Number:
Preferred Mailing Address:
Home  Work  
PA Program You Attended:
My work pays for my membership: :
Yes  No  
Membership Type:
Fellow ($150)  
Affiliate ($150)  
Associate ($50)  
Graduate ($75)  
Associate Nurse Practitioner ($150)  
Supporter ($150)  
Pre-PA Student ($25)  
Student (1st Year) ($25)  
Student (2nd year - select only if you were not a member your first year of PA school) ($25)  
Specialties in which I cuirrently practice::
Internal Medicine
Family Medicine
Emergency Medicine
Women's Health
General Surgery
Psychiatry/Behavioral Medicine
Internal Medicine Subspecialty
Surgical Subspecialty
Other
Committees I'm Interested In:
Board of Directors
Student Representative to the Board
Communications (Newsletter, website)
Membership
Legislative and Health Policy
Spring Conference
Fall Conference
AAPA HOD Delegate
Finance
Public Education
Awards
Exhibitor Liaison
I'm Interested In Being Available For Job Shadowing:
Yes  No  
Please condsider a donation to the IPAS Foundation:
Enter the Security Code: