AABIP Membership Form
 
 
 

 

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DO NOT include my name, address, contact information in the AABIP website membership roster.
 

Occasionally we receive requests for our membership roster from meeting planners or industry-related corporations. The Executive Committee reviews all requests for appropriateness. Please check the box below if you do not wish to have your member information released for mailing list requests.

DO NOT release my name, address, or contact information to any individual, institution, or corporation requesting the AABIP.
OTHER PROFESSIONAL MEMBERSHIPS (Please check all that apply)
(A) Japan Society for Bronchology
(B) American College of Chest Physician
(C) American Thoracic Society
(D) American College of Physicians
(E) European Respiratory Society
(F) Asociacion Sudamericana de Broncologia
(G) Asocacion Espanola de Endoscopica Respiratoria
(H) Other:
PRINCIPAL AREAS OF INTEREST & EXPERTISE (Please check only three.)
(I) Interventional Bronchoscopy
(J) Pleural Diseases and Thoracoscopy
(K) Lung Cancer Staging and Detection
(L) Ultrasonography
(M) Laser Tissue Interactions and Laser Physics
(N) Medical and Patient Education
(O) Virtual Reality and Computer Simulation
(P) Database Design and Analysis
(Q) Ethics and End of Life Issues
(R) Medical Economics
(S) Evidence-based Medicine and Outcome Analysis
(T) Health Care Technology Assessment
(U) Other:
UPDATED MEMBER INFORMATION
First Name
Last Name
Degree
  
Address
 City
State
 Zip/Post
 Country
Email
Daytime Phone - Ext.
- 		Daytime Fax
 
MEMBERSHIP TYPE (Please choose one.)

New Member  Renewal

AABIP plus WAB Dual ($200.00)

AABIP Only ($150.00)

WAB Only ($150.00)

AABIP Affiliate (Non-physician healthcare professional) ($80.00)

AABIP Trainee (Trainee verification letter from supervisor is required with this form.) ($80.00)
TOTAL
  
PAYMENT METHOD  
Visa MasterCard Check NOTE: This page is not hosted on a secure server.
Name of cardholder
 Credit card number
 Expiration date

Checks should be made payable to American Association for Bronchology. Mail payment to:

American Association for Bronchology
The Cleveland Clinic Foundation
9500 Euclid Avenue/A90
Cleveland, OH 44195 USA
Fax: 216.636.3137

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