Association For Professional Acupuncture
Membership Form

Name & Title:

Practice Name: (if different from above)

Office Address:

Office Telephone:

Home Telephone:

Fax:

Email:

Practice Web Address (if available):

Please send this form and your check made out to "APA" (75% of that money will be tax deductible. We cannot accept corporate checks.) to:

  • 150$ Standard Membership
  • 75$ First Year Practice
  • 50$ Student
 APA
POB 1081
Glenside, PA 19038