Membership Checkout – CENTRAL FLORIDA ASSOCIATION OF PHYSICIAN FROM THE INDIAN SUBCONTINENT

Membership Information

You have selected the Joint Annual (5-year pre-pay) membership level.

Joint 5-year prepaid membership for two members with full member benefits.

The price for membership is $900.00 now.

Membership expires after 5 Years.

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Account Information

Username

Password

Confirm Password

Email Address

Confirm Email Address

Full Name LEAVE THIS BLANK

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PERSONAL INFORMATION

First Name

Last Name

Gender

Male

Female

Cell Phone

Home Address

Address Line 2

City

State

Zip

Picture

Opt-IN

Show the phone number and/or email address in Member Directory

PROFESSIONAL INFORMATION

Primary Specialty

NPI Number

Practice Type

Website

Hospital Affiliation 1

Hospital Affiliation 2

Detailed Bio

CAPI INVOLVEMENT

Do you have an interest in

Volunteer Activities

Leadership Development

Committee Participation

MEMBER DIRECTORY (shared with members only)

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Do not show my Email Address

JOINT MEMBER INFORMATION

First Name

Last Name

Group Account Information

This purchase includes 1 additional seat.

Group members will be able to claim the Joint Secondary Member membership level.

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