AACM > [MEMBERSHIP] > MEMBERSHIP APPLICATION

	Get recognized as an expert by your peers in this exciting, emerging field of medicine.

NEW MEMBER APPLICATION

First Name*

Last Name*

Degree*

Position

Licence #*

Web Site

Date of Birth

Social Security #

Gender

Preferred Method of Contact

MAILING ADDRESS

Street Address*

City*

State*

Zip Code*

Country*

Check if billing and mailing address are the same

BILLING ADDRESS

Street

City

State

Zip Code

Country

EDUCATION

Medical School

Year Graduated

Degree

Graduation Year

Intership Location

Year Intership Completed

Residency Location

Residency Length

Year Residency Completed

Specialty Practice

Board Certification

Faculty Appointments

Research

CME in Cannabinoid Medicine

CME Credits in Last 4 Years

CURRENT PRACTICE

State License

License #

License Expiration

LimitedUnlimited

Other Licenses

State License

License #

License Expiration

LimitedUnlimited

State License

License #

License Expiration

Is License

LimitedUnlimited

PERSONAL INTERESTS

(Please check up to two areas of interest)

APPLICANT STATEMENT*

I have answered the above questions fully and frankly to the best of my knowledge.
I agree to pay all dies and fees.
I have read the standards and practices.
I agree to conduct my practice in an ethical manner in accord with the AACM practice standards, ethical guidelines and conflict of interest policies.

MEMBERSHIPS DUES CRITERIA

FELLOWSHIP $250 A Fellow is a member in good standing of the AACM who has been board certified by the AACM.

MEMBER $250 Members must possess a Phd, an MD degree, or the equivalent, and must have a cannabinoid related clinical practice and/or engage in cannabinoid research.

ASSOCIATE $250 Individuals have earned an MD or doctoral degree and are presently in the field, but have not yet met the criteria required to be members or fellows.

STUDENT $50 Student members must have already been awarded an undergraduate degree by an accredited college, and must be currently enrolled in school.

EMERITUS $50 An AACM member who has retired.

* Required

SPONSORSHIP DONATION CRITERIA

SUPPORTER $150+ Supporting members are individuals or organizations who support the field of cannabinoid medicine, but who does not wish to qualify as members or fellows.