Description of Membership Category

A member for whom payment of dues and/or special assessments would constitute a hardship by reason of physical disability, illness, or other reasons, provided the reasons are investigated and set forth by the member's component society or association and provided the member is excused from payment by that component society or association.

NOTE: This membership category requires renewal at the beginning of each fiscal year (June 1).

HOW TO APPLY:

Complete the below, enter the security code and click on submit.  Your completed document will be forwarded to your component society who may contact you if additional documentation is needed.  Your component will process your request and will notify APMA.

Member Name*:
E-mail:

APMA communicates many important issues via e-mail. 

Mailing Address*:    Home Office (please check one)
Telephone No.:  
(xxx-xxx-xxxx)  
Due to the following reason(s), I am applying for 5.4 Status Classification for the current fiscal year (June 1 - May 31).:  
  
Due to the above reasons, my practice has been curtailed by the following percent:  
  
I am requesting a dues curtailment for the current APMA fiscal year (June 1 - May 31) of:  
  
APMA Member No.:       (if known)
Date:     

Type the security code:

From: 
Email:  
To: 
Email:  
Subject: 
Message: