ACAP Application Request




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ACAP Application Request

I am a member of the Association of Chinese American Physicians (ACAP). Please send me a membership application at the special low introductory rate of $460 for ACAP members. Below is my contact information.

Personal Information: Fields with (*) are required

First Name (*):

Middle Name:

Last Name (*):

Office Address (*):

City (*):

Zip (*):

E-mail (*):

County (*):

Please check if applicable:

	Under age 40
	Within five years of completion of residency/fellowship
	In first or second year of practice

If you have any questions please e-mail them to Ruzanna Arsenian at rarsenian@mssny.org or if you wish to fill out the application over the phone please contact the Membership Division at 1-800-523-4405, Ext. 403 or 516-488-6100, Ext. 403