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Membership Details
Physician Member
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Member Price
$550.00
New Member Price
$645.00
Membership Description
MDs or DOs in the Domestic USA. This is the first level of membership for physicians.
Membership Information
This is an Anniversary based Membership
Membership Term
Effective Date:
12
Expiration Date:
1/18/2021
Referred By:
12/31/2021
Would You Like To Make A Donation?
If yes, please select a donation from the list below:
Donations:
Foundation for Venous & Lymphatic Disease
Additional Information:
When did you start phlebology?
I want UltrasoundAnnouncements:
I want Nursing Announcements:
Phlebology Patient Volume:
0-25%
26-50%
51-75%
76-100%
Board Certified in Phlebology:
Referral(See above)
Mailing
Web Search
Journal Ad
ACP Congress
Conference or Meeting
How did you hear about ACP?
Designation (MD, FACPh, DO):
State and License #:
University/ Medical School:
Post Graduate Training:
AMA Number:
Date of Birth:
Gender:
Male
Female
Graduation Date:
Cardiology/Int.Cardio
Cardiothoracic
Cosmetic Surgery
Dermatology/Derm.Surgery
Family/General Practice
General Surgery
OB/Gynecology
Inter.Radiology
Phlebology
Plastic Surgery
Vascular Surgery
Other
Current Primary Specialty:
Cardiology/Int.Cardio
Cardiothoracic
Cosmetic Surgery
Dermatology/Derm.Surgery
Family/General Practice
General Surgery
OB/Gynecology
Inter. Radiology
Phlebology
Plastic Surgery
Vascular Surgery
Other
n/a
Residency Specialty :
Current 2ndary Specialty:
Cardiology/Int.Cardio
Cardiothoracic
Cosmetic Surgery
Dermatology/Derm.Surgery
Family/General Practice
General Surgery
OB/Gynecology
Inter. Radiology
Phlebology
Plastic Surgery
Vascular Surgery
Other
Other Org (AVF, ACS, SVS, etc):
I attest to the validity of the info above.
Attestation Statement: