PAOS Membership Application

PAOS Member Benefits:
Advocacy for PAs practicing in orthopaedics National information resource for PAs practicing in orthopaedics Representing PAs practicing in orthopaedics to the American Academy of Orthopaedic Surgeons Representing PAs practicing in orthopaedics to the American Academy of Physician Assistants including voting privileges within the AAPA House of Delegates PAOS web site - www.paos.org PAOS Newsletter - PAOS News ORTHOPEDICS TODAY print publication Online membership directory Job placement service just for PAs practicing in orthopaedics Significant "member only discount " on the only CME conference just for PAs practicing in orthopaedics Opportunities for involvement in PAOS Board activities and committees Specific survey data for PAs practicing in orthopaedics Susan Lindahl Memorial Scholarship awarded annually
	*Note: This form is located on a secured server. If you prefer not to send your request in electronically you can print our form then mail or fax it to us.
Membership Type *	Fellow - Annual PAOS Membership ($75.00 for one year) PAs employed in orthopedics, certified by the NCCPA, and are members of the AAPA in good standing. Fellow - Annual PAOS Membership (2 years) ($150.00 for 2 years) PAs employed in orthopaedics, certified by the NCCPA, and are members of the AAPA in good standing. International Fellow - Annual PAOS Membership ($75.00 for one year) Physician Assistants who have graduated from a created international Physician Assistant/ Associate program. Members may not hold office but will be full voting members of the association. Associate - Annual PAOS Membership ($75.00 for one year) PAs who are graduates of a CAAHEP approved program but are not members of the AAPA. Must hold NCCPA certification. Applicant is granted all rights and privileges but may not hold office, vote on officers, or official PAOS matters. Student: Annual PAOS Membership ($25.00 for one year) PA students enrolled in an CAAHEP accredited PA program. Affiliate- Annual PAOS Membership ($100.00 for one year) Affiliate memberships include other supporters of the PAOS. Membership approval at the discretion of the PAOS Board of Directors. Allied Health - Annual PAOS Membership ($75.00 for one year) A clinically practicing and licensed Registered Nurse, Nurse Practitioner, Physical Therapist, Physical Therapy Assistant or Athletic Trainer. Applicant is granted all rights and privileges but may not hold office, vote on officers, or official PAOS matters.
Your Name * Your First & Last name
Your E-Mail Address * A confirmation email will be sent to you at this address
Enter Verification Text * Please type text from image
PA Title: *
Other Credential(s):
Gender *	Male Female No Answer
Specialty * Select your primary specialty. If you work in multiple specialties, select "General Orthopaedics"
Practice Name:
Practice Address:
Add'l Address:
Practice City:
Practice State:
Practice Zip Code:
Practice Website: Format: www.domain.com
Practice Phone #:
Home/Cell Phone * Not displayed in membership directory
AAPA Member #:
NCCPA Certification #:
PA Program Attended:
Year Graduated PA School:
PA student precepting? Would you be willing to be a PA student preceptor?	Yes No
Interested in CME speaking? If interested, what topic(s) would you be willing to present?
Volunteer with the PAOS? If interested, in what capacity would you be willing to help the PAOS?
Interested in writing? If interested, what topics would you be willing to write about?
PAOS Mailings to be sent to: *
How did you hear about PAOS? Select one	Friend AAPA Web Search
Friend's Name (If applicable) Please provide the name of your friend who recommended PAOS membership.
Home Address - Required
Country* *Not displayed in membership directory
Street* *Not displayed in membership directory

City* *Not displayed in membership directory
State* *Not displayed in membership directory
ZIP* *Not displayed in membership directory
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