APTA Membership Application Form
1. For individual Membership
1-1. Please choose your individual membership type.
Student (USD 70)
1 year Member (USD 100)
3 year Member (USD 270)
5 year Member (USD 400)
10 year Member (USD 700)
Lifetime Member (USD 1,000)
1-2. Payment Option
Please choose the method of payment. Receipt with the name of APTA will be issued for both methods.
Paypal
Bank Tranfer
1-3. Personal Information
Select title
Prof.
Dr.
Ms.
Mr.
1-4. Affiliation (Name of Organization)
Replace this with a title or description
2. For organizational Membership
2-1. Name of organization.
This will be appeared in all the ad materials.
2-2. Contact Person.
Please provide information of contact person.
Select title
Prof.
Dr.
Ms.
Mr.
2-3. Payment Option
Please choose the method of payment. Receipt with the name of APTA will be issued for both methods.
Paypal
Bank Tranfer
2-4. First person who will get APTA member benefit.
Please provide information of first person who will get APTA member benefit for the next fiscal year.
Select title
Prof.
Dr.
Ms.
Mr.
2-5. Second person who will get APTA member benefit.
Please provide information of the second person who will get APTA member benefit for the fiscal year of 2019.
Select title
Prof.
Dr.
Ms.
Mr.
Submit