SHM - Prospect Join

If you are a member of AAP or APA, please ensure you select the proper society option in the drop down menu below


Choose your Member Type
Select from the drop down box:  
required

Account Details
Prefix: 
First Name: 
required
Last Name: 
required
Title: 

Hospital/Employer: 

Email: 
required
Work Phone: 


Preferred Address
Address: 
required
 

 

City: 
required
State/Province: 
required
Zip/Postal code: 
required
Country: 

Medical Societies
Select from the
drop down box: 

Demographic Information
Gender: 

Hospital Medicine Group Name: 
Specialty(ies): 
Select from the drop down box

Website Security

Password must be alphanumeric and at least 7 characters long.

Username: 
required
Password: 
required

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