Apply for Membership

Thank you for your interest in becoming a member of the California Podiatric Medical Association. Please complete all applicable fields and be sure to hit "submit" to have your application sent to CPMA for processing. Once processed you will be sent a pro-rated dues quote to join APMA and CPMA via email. Please provide your preferred email address.

For more information on Association dues, please contact the CPMA at (800) 794-8988 or e-mail at jsteed (at) calpma.org.

If you are applying for resident membership, please do not use this application. Resident members should contact APMA directly at (800) 275-2762 for membership information or use the application found here (PDF).

We look forward to working with you!

CPMA Membership Application

Fields marked with * are required.

Personal Information
If changed due to marriage, divorce, etc.
Male Female
Please enter a date, MM/DD/YYYY, e.g., 6/17/1956.
For demographic use only.
 White  African American  Hispanic
 American Indian  Asian/Pacific
 Other
 Yes  No
Contact Information
Home Primary Office
Your home address is essential for identifying and contacting your federal and state legislators.
Please include area code.
Please include area code.
Please include area code.
CPMA and APMA communicate many important issues via e-mail, including membership information. Please be aware that your e-mail will NOT be shared with outside vendors.

Offices (Up to Three)

Primary Office
Please include unit or suite number if applicable.
Please include area code.
Please include area code.
Office #2
Please include unit or suite number if applicable.
Please include area code.
Please include area code.
Office #3
Please include unit or suite number if applicable.
Please include area code.
Please include area code.
Education
Undergraduate Degree
Graduate Degree
Check College Below
 Arizona  Barry  California (CSPM)  California (Western)
 Des Moines  New York  Ohio  Temple  Scholl
 Other
If you have more than two fellowships or residencies, please include in the comments field below.
 Yes (If yes, complete this section)  No
Postgraduate Education #1
 Fellowship
 Residency:
 Rotating Podiatric Residency (RPR)
 Podiatric Orthopedic Residency (POR)
 Primary Podiatric Medical Residency (PPMR)
 Primary Surgical Residency (PSR)
 Podiatric Medicine and Surgery Residency (PM+S)
Postgraduate Education #2
 Fellowship
 Residency:
 Rotating Podiatric Residency (RPR)
 Podiatric Orthopedic Residency (POR)
 Primary Podiatric Medical Residency (PPMR)
 Primary Surgical Residency (PSR)
 Podiatric Medicine and Surgery Residency (PM+S)
Military Service
Check any that apply:
 USA  USAF  USN  USMC  USCG
 Other
If in Reserves, branch of service:
Professional Licensure
Year*
YYYY
State*
Abbrev
Number*
E-####
Year State Number
Year State Number
Podiatric Medical Practice
If yes, please explain in comments section below.
Yes No
If yes, please explain in comments section below.
Yes No
If yes, please explain in comments section below.
Yes No
Please include any answers to the above questions that require explanation. Here you may also include the name of the member who recruited you.
By initialing here, I understand that after submitting this application, I will be billed for Association dues. The membership process will not be completed until dues payment is received and entered by CPMA. CPMA will inform APMA and my local society of my activated membership.
Initials: