Registration - TAAIS

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Register for TAAIS Membership Applications

This is an online application. Your membership will need to be approved and dues paid before you are able to access member content.

Step 1 of 4

25%

Name*
First Last
Spouse
First Last
Email*
Practice Website
Date of Birth*
MM slash DD slash YYYY

Office Address*
Street Address City State ZIP Code
Home Address
Street Address City State ZIP Code
Preferred Mail*
- Home
- Office
Office Phone*
Home Phone
Fax

Degree*
- PhD
- DO
- MD
- Other
If other, please specify
Professional Status*
- Full-Time Academic
- Private Practice
- Private & Academic
- Fellow Resident
Medical School Affiliation and/or Faculty Status
Specialty Boards
- ABIM
- ABP
Dates Served on Board
Certifications and Re-Certifications
- ABAI
Date Certified
Member Of
- TMA
- AMA
- AAAAI
- ACAAI
- Other
If other, please specify
Fellow of
- AAAAI
- ACAAI
Type of Membership Requested*
- Active
- Associate
- Affiliate

Education
Pre-Med or Graduate School*
Medical School*
Internship*
Residency or Fellowship*
Name of two active TAAIS Members who may be contacted and have agreed to serve as your Sponsors
1*
2*
CURRICULUM VITAE (CV) (upload a pdf)*
Accepted file types: pdf, Max. file size: 512 MB.
Please Upload a PDF version of your CV. This is a detailed document that highlights your academic background and qualifications including education, work experience, research and publications, presentations, and awards and honors.

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