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Application for Membership to the Connecticut Chapter of the American Academy of Pediatrics

After filling out the application below, click SEND APPLICATION. Your application will be readied for transmission as an email attachment. Please follow your normal email procedures to complete the transaction.Your application will be readied for transmission as an email attachment. Please follow your normal email procedures to complete the transaction.

Alternatively, PRINT your completed application and FAX or MAIL to CT-AAP, 104 Hungerford Street, Hartford, CT 06106.

In the PAY HERE section beneath the application, select the membership term for which you are applying, then pay your membership dues by credit card directly to our PayPal account. Your payment will be acknowledged, typically within less than an hour. Thereafter, we will link your payment to your application and confirm your application via email to the address on your application within 1-2 business days.
 

BOTH APPLICATION AND PAYMENT MUST BE RECEIVED TO ACTIVATE YOUR MEMBERSHIP
 
Click here to open application PDF
 


 


PAY HERE Specify Membership Term   PAY HERE


After filling out the application above, click SEND APPLICATION. Your application will be readied for transmission as an email attachment. Please follow your normal email procedures to complete the transaction.

In the PAY HERE section, select the term of membership for which you are applying, then pay your membership dues by credit card directly to our PayPal account. Your payment will be acknowledged, typically within less than an hour. Thereafter, we will link your payment to your application and confirm your application via email to the address on your application within 1-2 business days.

BOTH APPLICATION AND PAYMENT MUST BE RECEIVED TO ACTIVATE YOUR MEMBERSHIP


NOTE: The form above may not work with some browsers.
 
If you encounter a problem, please print this form and fill it out by hand,
select membership term,
click the PayPal Payments button to pay on-line,
then fax your completed application form to 860-727-9863 or mail to the address listed on the bottom of the form.

If you have any questions, please feel free to email us at membership@ct-aap.org.

 




Questions?

E-mail: staff@ct-aap.org or call: 860-977-3430

PHONE: 860-525-9738 FAX: 860-727-9863 E-MAIL 101 Oak Street Hartford, CT 06106