ACOFP Student Member Application
First Name *
Middle Initial
Last Name *
AOA ID
Student Year for 2020-2021 academic year *
COM *
Mailing Address *
City *
State *
Zip Code *
Email *
Mobile Phone *
Would you like to receive occasional text messages from ACOFP?
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To which gender identity do you most identify? *
Date of Birth
MM
/
DD
/
YYYY
Have you ever been denied membership? *
Have you ever been denied membership in a County/District of State of Osteopathic Society or have you been convicted of a felony or violation of any state or federal narcotics act?
Signature *
In signing this form, I certify that the information provided is correct and complete, and do hereby agree to abide by the Constitution and Bylaws of the American College of Osteopathic Family Physicians. I agree to accept the Board of Governors of ACOFP as the sole and only judge of my qualifications to be and remain a member. I understand that any money submitted will be refunded if my application is not approved.
Questions? Please contact the ACOFP Membership Department at membership@acofp.org.
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