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Membership Type *	AABIP Only ($150.00 for each year) \| AABIP membership only AABIP Affiliate ($80.00 for each year) \| Non-physician healthcare professional. NOTE: Verification required. AABIP Trainee ($80.00 for each year) \| Verification letter from supervisor is required with this level.
Payment System *	PayPal Secure credit card payment
Your Name * Your First & Last name
Your E-Mail Address * A confirmation email will be sent to you at this address
Choose a Login Name (User ID) * It must be 4 or more characters in length and may only contain small letters, numbers, and the underscore '_'
Choose a Password * Must be 4 or more characters
Confirm your password * Enter password again
Enter Verification Text * Please type text from image
New Membership or Renewal? Please indicate if this is a new or renewal membership.	New Renewal
Medical Affiliation * Your medical organization
Institution your medical institution
Website Listing * DO NOT include my contact information on the AABIP website membership roster.	No, do not include my contact info. Yes, ok to include my contact info.
Mailing List * DO NOT release my contact information to any third party requesting the membership roster.	Do not release my contact info. Ok to release my contact info.
Other Professional Memberships Please check all that apply.	Japan Society for Bronchology American College of Chest Physician American Thoracic Society American College of Physicians European Respiratory Society Asociacion Sudamericana de Broncologia Asocacion Espanola de Endoscopica Respiratoria Other (fill in field below)
Other Professional Memberships Other professional memberships not listed above.
Areas of Interest/Expertise Your principal areas of interest and expertise	Interventional Bronchoscopy Pleural Diseases and Thoracoscopy Lung Cancer Staging and Detection Ultrasonography Laser Tissue Interactions and Laser Physics Medical and Patient Education Virtual Reality and Computer Simulation Database Design and Analysis Ethics and End of Life Issues Medical Economics Evidence-based Medicine and Outcome Analysis Health Care Technology Assessment Other (fill in field below)
Other Areas of Interest Other areas of interest and expertise not listed above.
Degree Your degree(s)
Specialty Your medical specialty
Address * Your address
Address2 second line for address
City * Your city
State * Your state/province
Zip/Post Code * Your Zip/Post Code
Country * Your country
Phone * Your daytime phone
Fax fax number
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Middle Name
Country*
State*
City*
Street*
ZIP*

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American Association for Bronchology and Interventional Pulmonology

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