ASPMA Application

  1. It is now easy to become a Member by processing your application and payment online. There are several steps needed for us to process your application.

    • Step 1: Complete the Online application
    • Step 2: Process payment through Paypal (Major Credit Cards accepted)

    As soon as your application is processed we will mail you your membership card and pin. You will also receive our quarterly ASPMA Journal.

  2. Applicant Information

  3. First Name(*)
    Please type your first name.
  4. Middle Name
    Please type your middle name.
  5. Last Name(*)
    Please type your last name.
  6. Name Wanted On Badge(*)
    Complete name wanted on badge.
  7. Address(*)
    Complete address please.
  8. City(*)
    City please.
  9. State(*)
    State please.
  10. Zip Code(*)
    Zip Code please.
  11. Phone ###-###-####(*)
    Format ###-###-####
    ###-###-####

  12. Employment Information

  13. Podiatrist Name(*)
    Invalid Input
  14. Physician's APMA Membership#(*)
    Please note you must enter a valid APMA Membership Number. Only enter numbers.
  15. Notice: Please note you must enter a valid APMA Membership Number. ASPMA will validate your physician's APMA Membership number before your membership application is finalized.
  16. Address(*)
    Invalid Input
  17. City(*)
    Invalid Input
  18. State(*)
    Invalid Input
  19. Zip(*)
    Invalid Input
  20. Phone ###-###-####(*)
    Invalid Input
  21. Fax ###-###-####
    Invalid Input
  22. Employed Years
    Invalid Input
  23. Employed Months
    Invalid Input
  24. ____________________________
  25. Your Email Address(*)
    Invalid Input
  26. How did you hear about us?
    Invalid Input

  27. APPLICANT MUST BE EMPLOYED BY A DOCTOR WHO IS A MEMBER IN GOOD STANDING OF THE AMERICAN PODIATRIC MEDICAL ASSOCIATION.

  28. Application fee is $90.00 U.S. dollars, plus an additional $5.00 online fee processing charge.This covers the initial cost of society pin, name badge, certificate and current year dues. For assistants joining in August or after, the initial dues will cover the remainder of the year and the following year.
  29. Name on the Credit Card:(*)
    Invalid Input
    Enter Name of the Credit Card Holder you will use to purchase the membership.
  30. Click the Submit link to submit your application. You will need to then follow the instructions on the next page to process your application fees.
  31. Please enter the code seen here.
    Please enter the code seen here.
    Invalid Input
  32. Submit