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Contact Information

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I consent to the society sending me email correspondence relating to my membership, meeting attendance, meeting submissions or other society programs.
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Professional Details

Have you completed medical school?*
When did/will you complete medical school?
Medical, NP, or PA school name (or list "N/A")
Have you completed a residency program?*
When did/will you complete your residency?
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When did/will you complete your fellowship?
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If MD/DO: list specialties or sub-specialties.

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Areas of Expertise*
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Certifications

Are you ABPN Board Certified?*
Are you a member of the AMA?*
Are you a member of the APA?*
Do you have a waiver to prescribe buprenorphine?*
What is your primary practice setting?*

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What is your primary role?*

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Licensing State

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By providing your Date of Birth (DOB), Licensing State, and Licensing ID, you agree to allow AAAP to submit your CME credits to CME Passport.

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How did you hear about AAAP membership?*

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AAAP’s Patient Referral Program provides a list of Addiction Psychiatrists and their contact information. Would you like to participate in our Patient Referral Program?
When you participate in the AAAP Patient Referral Program, patients who are seeking treatment in your area will be able to find your contact information easily.
Display in member directory

By submitting this form, I agree to abide by the Charter and Bylaws of the American Academy of Addiction Psychiatry. I understand that the organization will review my application and my references. I will hold the Academy, its' members, examiners, officers, employees and agents free from all damage and complaint by reason of any action taken on this application or by reason of any subsequent action on membership. I pledge myself to high standards of ethical practice. Being a member of the Academy DOES NOT, at any time or by any means, make me a representative of the organization nor give me the right to speak on its' behalf.

PLEASE NOTE: All membership applications will be screened. AAAP does not endorse or support the membership of each member or respective organization. Upon becoming a member, you are not a representative of the organization. Members will not speak on behalf of the organization unless asked by the CEO or the Board of Directors. Membership information pertaining to fellow Academy members is not for solicitation, distribution or unauthorized use. Members using the membership directory or member information inappropriately could face termination. The Academy will review applications and references as it sees fit. Members will hold the Academy, its members, examiners, officers, employees and agents free from all damage and complaint by reason of any action taken on an application or by reason of any subsequent action on membership.