Association of Psychiatric Physican Assistants (APPA)
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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_____


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

Thank You for Supporting APPA!
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