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New Membership
Only one membership per person will be processed. Please do not order multiple memberships
Constituent Agency	Select Air Force (USAF) Air Force Reserve (USAFR) Air National Guard (ANG) Army (USA) Army National Guard (ARNG) Army Reserve (USAR) Coast Guard (USCG) Navy (USN) Navy Reserve (USNR) Public Health Service (USPHS) Dept of Veterans Affairs (DVA) Foreign Service Other
Professional Discipline	Select Student Physicians Assistant Chaplain Dentist Podiatrist Enlisted Social Worker Lawyer Physician Nurse Optometrist Pharmacist Occupational Therapist MSC/Administration Physical Therapist Dietician Veterinarian Psychologist Bioscientist Other
Rank	Select Civilian General Admiral Lieutenant General Vice Admrial Major General (8) Rear Admiral Brigadier General (7) Rear Admiral Colonel Captain Lieutenant Colonel Commander Major Lt Commander Captain Lieutenant First lieutenant Lt Junior Grade Second Lieutenant Ensign Command Sgt Major Chief Master Sgt Master Chief PO Sergeant Major Master Sgt Senior Master Sgt Sr Chief PO Sgt 1st Class Chief PO Staff Sgt Technical Sgt 1st Class PO Sergeant Staff Sergeant 2nd Class PO
Physician Primary Specialty	Select Alternative Medicine Medical Director Abdominal Surgery Adolescent Medicine Aerospace Medicine Allergy Anesthesiology Broncho-Esophageal Critical Care Child Neurology Child Psychiatry Clinical Pathology Clinical Pharmacy Cardiovascular Disease Cardiovascular Surgery Colon & Rectal Surgery Dermatology Diabetes Diagnostic Radiology Emergency Medicine Endocrinology Family Practice Forensic Pathology Gastroenterology Geriatrics General Practice General Preventive Medicine General Surgery Gynecology Hematology Head and Neck Surgery Hand Surgery Hypnosis Immunology Infectious Disease Internal Medicine Laryngology Legal Medicine Maxillofacial Surgery MD Nephrology Neuropathology Neurology Nuclear Medicine Neonatal-Perinatal Neurosurgery Nuclear Radiology Nutrition Obstetrics and Gynecology Obstetrics Occupational Medicine Oncology Opthalmology Orthopaedic Surgery Other Otology Otorhinolaryngology Pathology Pediatrics Pediatric Allergy Pediatric Endocrinology Pediatric-Hemo Oncology Pediatric Nephrology Pediatric Radiology Pediatric Surgery Physical Medicine PhD Plastic Surgery Psychoanalysis Psychiatry Public Health Pulmonary Disease Radioisotopic Pathology Rhinology Rheumatology Thoracic Surgery Therapeutic Radiology Traumatic Surgery Urology
Physician Secondary Specialty	Select Alternative Medicine Medical Director Abdominal Surgery Adolescent Medicine Aerospace Medicine Allergy Anesthesiology Broncho-Esophageal Critical Care Child Neurology Child Psychiatry Clinical Pathology Clinical Pharmacy Cardiovascular Disease Cardiovascular Surgery Colon & Rectal Surgery Dermatology Diabetes Diagnostic Radiology Emergency Medicine Endocrinology Family Practice Forensic Pathology Gastroenterology Geriatrics General Practice General Preventive Medicine General Surgery Gynecology Hematology Head and Neck Surgery Hand Surgery Hypnosis Immunology Infectious Disease Internal Medicine Laryngology Legal Medicine Maxillofacial Surgery Nephrology Neuropathology Neurology Nuclear Medicine Neonatal-Perinatal Neurosurgery Nuclear Radiology Nutrition Obstetrics and Gynecology Obstetrics Occupational Medicine Oncology Opthalmology Orthopaedic Surgery Other Otology Otorhinolaryngology Pathology Pediatrics Pediatric Allergy Pediatric Endocrinology Pediatric-Hemo Oncology Pediatric Nephrology Pediatric Radiology Pediatric Surgery Physical Medicine Plastic Surgery Psychoanalysis Psychiatry Public Health Pulmonary Disease Radioisotopic Pathology Rhinology Rheumatology Thoracic Surgery Therapeutic Radiology Traumatic Surgery Urology
Enlisted Specialty	Select Administration Dental Technician Environmental, includes Vet Laboratory Technician Medical Technician Mental Health Nursing Service Pharmacy Technician Preventive Medicine Radiology Technican
Membership Options	Select - $0 3 year - $160 2 year - $105 1 year - $55 Student - $22 Pro-Rated Life-every yr for 5 yrs - $200 One-time full Life member payment - $1000

   

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Renewing Membership
Only one membership per person will be processed. Please do not order multiple memberships.
Constituent Agency	Select Air Force (USAF) Air Force Reserve (USAFR) Air National Guard (ANG) Army (USA) Army National Guard (ARNG) Army Reserve (USAR) Coast Guard (USCG) Navy (USN) Navy Reserve (USNR) Public Health Service (USPHS) Dept of Veterans Affairs (DVA) Foreign Service Other
Professional Discipline	Select Student Physicians Assistant Chaplain Dentist Podiatrist Enlisted Social Worker Lawyer Physician Nurse Optometrist Pharmacist Occupational Therapist MSC/Administration Physical Therapist Dietician Veterinarian Psychologist Bioscientist Other
Rank	Select Civilian General Admiral Lieutenant General Vice Admrial Major General (8) Rear Admiral Brigadier General (7) Rear Admiral Colonel Captain Lieutenant Colonel Commander Major Lt Commander Captain Lieutenant First lieutenant Lt Junior Grade Second Lieutenant Ensign Command Sgt Major Chief Master Sgt Master Chief PO Sergeant Major Master Sgt Senior Master Sgt Sr Chief PO Sgt 1st Class Chief PO Staff Sgt Technical Sgt 1st Class PO Sergeant Staff Sergeant 2nd Class PO
Physician Primary Specialty	Select Alternative Medicine Medical Director Abdominal Surgery Adolescent Medicine Aerospace Medicine Allergy Anesthesiology Broncho-Esophageal Critical Care Child Neurology Child Psychiatry Clinical Pathology Clinical Pharmacy Cardiovascular Disease Cardiovascular Surgery Colon & Rectal Surgery Dermatology Diabetes Diagnostic Roenterology Emergency Medicine Endocrinology Family Practice Forensic Pathology Gastroenterology Geriatrics General Practice General Preventive Medicine General Surgery Gynecology Hematology Head and Neck Surgery Hand Surgery Hypnosis Immunology Infectious Disease Internal Medicine Laryngology Legal Medicine Maxillofacial Surgery MD Nephrology Neuropathology Neurology Nuclear Medicine Neonatal-Perinatal Neurosurgery Nuclear Radiology Nutrition Obstetrics and Gynecology Obstetrics Occupational Medicine Oncology Opthalmology Orthopaedic Surgery Other Otology Otorhinolaryngology Pathology Pediatrics Pediatric Allergy Pediatric Endocrinology Pediatric-Hemo Oncology Pediatric Nephrology Pediatric Radiology Pediatric Surgery PhD Physical Medicine Plastic Surgery Psychoanalysis Psychiatry Public Health Pulmonary Disease Radioisotopic Pathology Rhinology Rheumatology Thoracic Surgery Therapeutic Radiology Traumatic Surgery Urology
Physician Secondary Specialty	Select Alternative Medicine Medical Director Abdominal Surgery Adolescent Medicine Aerospace Medicine Allergy Anesthesiology Broncho-Esophageal Critical Care Child Neurology Child Psychiatry Clinical Pathology Clinical Pharmacy Cardiovascular Disease Cardiovascular Surgery Colon & Rectal Surgery Dermatology Diabetes Diagnostic Roenterology Emergency Medicine Endocrinology Family Practice Forensic Pathology Gastroenterology Geriatrics General Practice General Preventive Medicine General Surgery Gynecology Hematology Head and Neck Surgery Hand Surgery Hypnosis Immunology Infectious Disease Internal Medicine Laryngology Legal Medicine Maxillofacial Surgery Nephrology Neuropathology Neurology Nuclear Medicine Neonatal-Perinatal Neurosurgery Nuclear Radiology Nutrition Obstetrics and Gynecology Obstetrics Occupational Medicine Oncology Opthalmology Orthopaedic Surgery Other Otology Otorhinolaryngology Pathology Pediatrics Pediatric Allergy Pediatric Endocrinology Pediatric-Hemo Oncology Pediatric Nephrology Pediatric Radiology Pediatric Surgery Physical Medicine Plastic Surgery Psychoanalysis Psychiatry Public Health Pulmonary Disease Radioisotopic Pathology Rhinology Rheumatology Thoracic Surgery Therapeutic Radiology Traumatic Surgery Urology
Enlisted Specialty	Select Administration Dental Technician Environmental, includes Vet Laboratory Technician Medical Technician Mental Health Nursing Service Pharmacy Technician Preventive Medicine Radiology Technican
Membership Options	Select - $0 3 Year - $160 2 Year - $105 1 Year - $55 Pro-Rated Life 2007 - $200 Pro-Rated Life 2006 - $150 Pro-Rated Life 2005 - $135 Pro-Rated Life prior to 2005 - $105 Fully Paid Life - $1000 Student - $22
Membership ID number:

   

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