MEMBERSHIP/DUES FORM

Association of Chairs of Departments of Physiology
    9650 Rockville Pike, Suite E314
        Bethesda, Maryland 20814-3991
            Tel. 301-634-7785; Fax: 301-634-7098

Credit Card Payments: Go online to the APS Members-only Page
(Thanks to the generosity of The American Physiological Society, ACDP membership is now handled through an Association Management System on the APS website.)

Check payments:  Make checks payable to ACDP and return the check with this form
(For Tax Purposes, if required: Federal Tax Identification Number (F.E.I.N.) is 52-2100837)

ACDP can provide you with a payment form should you need one. Email ACDP Office for a form. 

For New Chairs: Please contact ACDP Office first with new chair’s contact information to pay by credit card or return this form with your check.

                                                                                 
Last Name, First Name, Middle Initial

                                                 
Title (Ph.D., M.D., D.V.M., D.O.)

                                                                                 
Department

                                                                                 
University

                                                                                 
College or School

                                                                                 
Street

                                                                                 
City, State, Country, Postal Code

                                                                                 
Telephone

                                                                                 
Fax

                                                                                 
Email

Dues are $250/year.
Checks can be made payable to ACDP 
 

Return to:
Melinda Lowy
Executive Assistant, ACDP
Suite E314
9650 Rockville Pike
Bethesda, MD 20814-3991
mlowy@the-aps.org
301-634-7098 (fax)

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Send mail to mlowy@the-aps.org with questions or comments about this web site.
Copyright © 2010 Association of Chairs of Departments of Physiology
Last modified: September 01, 2010