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Name: ______________________________________________________________________
Email (most important info): _____________________________________________________
Home or work (circle) address for paper correspondence:
____________________________________________________________________________
____________________________________________________________________________
Work Phone: ____________________________ Home Phone: ________________________
Include personal information in HAPA directory? ___ Yes ___ No
MEMBERSHIP CATEGORIES (check ONE)
____ Fellow: $50 (for PAs who are NCCPA certified and/or a graduate of a CAHEA or CAAHEP accredited PA program; a fellow shall live or be employed in Hawaii and must be a member of AAPA)
____ Affiliate: $50 ( individuals who qualify for Fellow membership but elect not to be a member of the AAPA, are members of another constituent chapter, or are non-PAs--i.e. physicians, pharmaceutical industry
____ Military: $25 (Active duty military stationed in Hawaii)
____ Student: $10 (student in a CAAHEP accredited PA program)
Would you like to be more involved with HAPA? There are several committees that could use your help:
PUBLIC RELATIONS
CONFERENCE/CME PLANNING
FUNDRAISING
NEWSLETTER
LEGISLATIVE/GOVERNMENTAL AFFAIRS
Circle the committees that interest you and you will be directed to the person in charge.
Please make checks payable to: Hawaii Academy of Physician Assistants
Attn: Membership/Rhiarose Magbitang
P.O. Box 30355
Honolulu, HI 96820-0355
Membership dues must be received by January 31, 2008. Mahalo!
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