Active Membership Application

Personal Information

To apply by mail or fax, download a Membership Application.

* = Required

Name

Address


Address designated as preferred is required. *

Business Address

Home Address

Phone and Email

Phone associated with preferred address is required.*




If applicant has never been an Active or Supporting FP member, or has not held Active or Supporting FP membership within the last two years, CME credits are not required. If the applicant has held Active or Supporting FP membership within the last two years, the applicant must provide evidence of 100 approved CME credits completed during the two years immediately preceding application. Please submit CME records to the AAFP Contact Center, 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2672. You can also fax your CME records to Attn: AAFP Contact Center, (913) 906-6075.