Membership Application | Consortium for Advanced Practice Providers

The Consortium for Advanced Practice's dues-based membership program provides a platform for our community to network, to participate in sharing expertise, wisdom and best practices. The Consortium exists to support new and ongoing postgraduate training programs for nurse practitioners and physician assistants in the achievement and maintenance of the highest standards of rigor and quality, consistent with achieving the goal of an expert healthcare workforce prepared to meet the needs of patients and the society as a whole.

Individual Application

Thank you for your interest in our membership program! Our member types are as follows:

Professional (Nurse Practitioner, Physician Associate/Assistant, MD/DO): $150
Professional (Non-Clinical): $100
Student/Trainee: $75

Start your individual membership application by clicking Next. If you have any questions, contact us here.

Membership Dues

Membership Type *

Contact Information

Email *

Re-enter your email *

Prefix

First Name *

Middle

Last Name *

Suffix

Title *

Informal Name

Company *

Address 1 *

Address 2

Address 3

City *

State *

Zip Code *

Country

Website

Personal LinkedIn URL

Personal Twitter URL

Personal Facebook URL

Company LinkedIn URL

Company Twitter URL

Company Facebook URL

Profile Photo

Phone Number *

Fax Number

My profile will be included in the Member Directory *
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I would like to receive updates from the Consortium via email. *
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Username/Password Username/Password

Please enter the Username/Password you would like to use to login to this website.

Your Username must be unique and must be at least 6 characters.
Passwords must be a minimum of 8 alpha-numeric characters with at least 1 number or 1 letter.

Username *

Password *

Confirm Password *

Additional Information

Select your Role

Are you Board Certified? *

Credentials (Select all that apply) *

Are you currently listed in the National or Canadian Register? *
Yes
No

What department do you work in?

Highest Degree Earned *

Institution Granting Highest Degree *

Select your interests

What is the name of your Postgraduate Program?

Payment Details

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Enter the name on the bank account according to the information shown on your bank statement. The account number and routing number can be copied from the lower left corner of the check.

Bank Name:
Bank Account Holder Name:
Routing Number:
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Account Type:

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Expires:

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PO #:

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Enable Automatic Renewals? *

Select "Yes" in order to be enrolled in automatic membership renewal. The above payment method will become your saved payment method, overwriting anything that may have been previously saved and will be used for future renewals. You can change the automatic renewal setting or saved payment method at any time in either the "Payment Method" or "Membership Auto-Renewal" tabs where you edit your profile.

No Yes

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Individual Application

Membership Dues

Contact Information Contact Information

Username/Password Username/Password

Additional Information Additional Information

Payment Details Payment Details

Member Links

Contact Information

Additional Information

Payment Details