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ASSOCIATION OF PSYCHIATRIC PHYSICIAN ASSISTANTS, INC |
| Welcome to the APPA web site. The Association of Psychiatric Physican Assistants, Inc. (APPA) is a nonprofit organization of Physican Assistants who work in the area of mental health care. The APPA is the only officially recognized association for PA's in psychiatry and mental health by the American Academy of Physician Assistant. |
| MEMBER APPLICATION |
ASSOCIATION OF PSYCHIATRIC PHYSICIAN ASSISTANTS
(APPA)
C/O Don St.John PA
4968 400th St SE
Iowa City, IA 52240
319-341-9115
319-353-7788 (fax)
don-stjohn@uiowa.edu
MEMBERSHIP APPLICATION |
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LAST NAME___________________________________ FIRST NAME___________________________________
WORK ADDRESS_____________________________________________________________________________
CITY_______________________________________ STATE_____________________ ZIP________________
PHONE_________________________ FAX____________________
E-MAIL___________________________________________________________________________________
HOME ADDRESS_____________________________________________________________________________
CITY_______________________________________ STATE_____________________ ZIP________________
PHONE______________________________________ FAX___________________________________________
E-MAIL___________________________________________________________________________________
I prefer to be contacted at home_______ work________
AAPA MEMBER NUMBER_________________________ NCCPA NUMBER_________________________________
PA PROGRAM YOU GRADUATED FROM____________________________________________________________
DATE OF GRADUATION__________________________________ YEARS AS A PA________________________
YEARS WORKING AS A PA IN MENTAL HEALTH____________________________________________________
DEGREE(S)_________________________________________________________________________________
May we include your name on a mailing list to be given or sold to professional organizations (not for advertising
purposes), such as journals, other health care organizations, etc? YES________ NO__________
Would you be willing to be a preceptor for PA students doing a mental health rotation? Yes_____ NO_____
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| 2005 MEMBERSHIP FEE (AAPA members) $25.00 |
| 2005 MEMBERSHIP FEE (non-AAPA members) $50.00 |
| 2005 STUDENT MEMBERSHIP FEE $10.00 |
| Don St. John MA, PA |
Looking for information about the APPA, you can reach the President of the APPA right here. Don St. John
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| Thank You for Supporting APPA! |
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Medifocus
Peripheral Neuropathy
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