General Member Eligibility Verification Form

Yes, I meet the General Membership requirements listed above.

Name of Residency Program:
Start date:
End date:
State and License Number:

Note Members who have completed training but have not passed the USMLE may remain as a member for up to one year after training completion.

Please provide current mailing address:
Phone:
Email:
Member Name
Member ID:
 

General Member Eligibility Verification Form

You may also download the General Member Eligibility Verification Form and submit the completed form by email, fax, or mail.

membership@psych.org

703-907-1085 (fax)

American Psychiatric Association

1000 Wilson Blvd. Suite 1825
Arlington, VA 22209-3901

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