Membership Form
An individual, not currently on the faculty or staff of one of PAEA's member programs, with an interest in PA education. PAEA individual colleagues are not voting members, but receive these benefits for very reasonable dues:
- Monthly PAEA Networker
- Quarterly Journal of Physician Assistant Education
- Member rates to PAEA conferences
Individual colleague members may serve as members of PAEA committees, subcommittees, or workgroups; however, they are not eligible to serve as a member of the board of directors or as a committee chair.
Dues: $75 annually
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Most fields are optional. For example, if you would like periodic email updates, then provide an email and indicate your areas of interest. If you want us to contact you directly, then provide your name plus a phone or email.
A few fields are required, we marked them with a *
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Your Information
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* First Name |
* Last Name |
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Login Information
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* Username
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* Password
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* Confirm Password
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Note: Your username can be your email, or another preferred internet login.
Your password should be at least 7 characters long and should
not resemble or contain your login name.
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* Secret Question
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* Answer
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Address and Contact Information
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Address |
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City |
State/Province |
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Zip/Postal |
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Country
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Office Phone |
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Fax
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* Email
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* Confirm Email
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Organization Information
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Title |
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Address |
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City |
State/Province |
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Zip/Postal |
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Country
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Main Phone
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Toll-free
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Fax
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Please Choose a Membership Type
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