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ADDRESS INFO
Membership Type *	AFFILIATE ($100.00) FELLOW ($75.00) PHYSICIAN ($100.00) STUDENT ($30.00)
Payment System *	PayPal secure credit card payment
Your Name * Your First & Last name
Your E-Mail Address * A confirmation email will be sent to you at this address
Choose a Login Name (User ID) * It must be 4 or more characters in length and may only contain small letters, numbers, and the underscore '_'	check for uniqueness
Choose a Password * Must be 4 or more characters
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AAPA AAPA#
Program Students
Date Of Graduation Students
Phone * Your Phone Number
Gender *	male female
Occupation * Your Medical Occupation
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