2020 EARLY CAREER MEMBERSHIP INFORMATION AND APPLICATION





This membership category has been created to support individuals as they transition from their training to their first independent position, and carries the same benefits and stature as Regular membership, but with reduced dues. This membership rate ($150/year) is available for two years following the conclusion of training.

 

*First Name:
*Last Name:
*Degree:
*Birthdate(year only):
*Telephone:
Fax:
*Email:
*Preferred Mailing Address:
*City:
*State/Province:
*Zip/Postal Code:
*Country:
Title:
*Institution/Organization:
 

*Description of Professional Activity and Responsibilities

Teaching:
Patient Care:
Research:
 

*What percentage of your time do you spend in each of the following areas? (total should equal 100%)

Patient Care:
Teaching:
Research:
Student:
 

*In your present position, do you have administrative duties?

 

Demographic Information

Race: White
Black or African American
Asian & Indian Subcontinent
Native Hawaiian & Other Pacific Islander
American Indian or Alaskan Native
Other:
 
Ethnicity Hispanic
Non Hispanic:
 
Gender: Male
Female
Gender non-binary
 

Educational History

*University
*Terminal Degree
*Month/Year

University
Degree
Year

University
Degree
Year

*Current Discipline (check all that apply):

Psychiatrist
Internist
Pediatrician
Psychologist
Sociologist
Nurse
Social Worker
Epidemiologist
Other:
 

*Interests (check all that apply):

Consultation/Liaison
Behavioral Medicine
Psychotherapy
Pharmacology
Physiology
Social Systems
Biochemistry
Epidemiology
Central Nervous System
Cardiovascular
Complementary Treatment
Lifespan/Development
Intervention
Quantitative
Endocrine
Immunologic
Gastrointestinal
Oncology
Musculoskeletal
Metabolism
Pulmonary
Renal
Genitourinary
AIDS
Pain
Health Services Research
Women's Health
Behavioral Genetics
Medical Education
Diabetes
Obesity
Epigenetics
Aging
Sleep
LGBTQ
 

*Please indicate how you learned about APS (check all that apply):

Mentor
Colleague
Printed Material
Psychosomatic Medicine Journal
APS Website
Other
 
 

* How will you be paying for your membership fees?


Credit card online
Mail a check