AAPI GKC Membership Renewal

AAPI GKC Membership Renewal
Member Information
This form allows registration for a single membership to the American Association of Physicians of Indian Origin of Greater Kansas City. If you would like to process multiple memberships please contact society management company VisionMinder at rebekah@visionminder.com or call 913-213-1819.

Membership options:

$250 New physician member (Two-year membership, includes entrance for you and one guest to the annual Gala both years and CME credits provided at activities)

$100 Annual renewal of physician membership (Includes entrance for you and one guest to the annual Gala and CME credits provided at activities)

$1,000 Lifetime Physician Membership (Includes entrance for you and one guest to the annual Gala and CME credits provided at activities. Benefits for Lifetime members will vary at events and will be announced with each event.)
Name*

First NameLast Name
Professional Credentials*
Medical Specialty*
Internal Medicine, Neurology, Ophthalmology, etc.
Email*
example@example.com
Mobile Phone Number*

Area CodeThis number will be kept private and be used to add you to the AAPI-GKC WhatsApp group chat for members.
Office/Practice Name*
Office Phone Number

This number will be placed on the physician directory on the aapigkc.org website
Home Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are you an active member of the national AAPI USA?

YesNo
Preference and Gala Information

To assist us in planning events, please provide your diet and beverage preferences.
Do you plan to attend this AAPI GKC Gala on April 4?

YesNo
After hitting submit on this form, you will be automatically directed to the Eventbrite RSVP site where you can provide your RSVP and guest name (if applicable) for the Gala.
Preferred Diet:

VegetarianNon Vegetarian
Preferred Beverages:

AlcoholNo Alcohol
Payment
Membership Preference

New Member - $250 (Two year membership)Annual Renewal - $100Lifetime membership - $1,000
Preferred payment method:

PayPal (accepts all major credits card and/or debit cards - no PayPal Account is needed)Direct Payment via Zelle
Direct payment via Zelle:

Please remit appropriate payment amount ($100 renewal, $250 for new member, or $1,000 for lifetime membership) after submitting this form.

Send Zelle payment as follows:

Zelle transfer to aapi.gkc@gmail.com
Please note, payment will show on statement as sent to VisionMinder LLC (rebekah@visionminder.com), VisionMinder is the AAPI GKC management company.
My Products
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Renewal - 2020 Physician Membership for AAPI-GKC$100.00

New Member - Physician membership for AAPI-GKC$250.00
This membership is valid for your first two years in AAPI-GKC, renewal will not be required until 2022.

Lifetime - Physician Membership for AAPI-GKC$1,000.00
This Lifetime Membership will provide additional benefits for the member. Benefits for Lifetime members will vary at events and will be announced with each event.

Total $0.00
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AAPI GKC Membership Renewal

Member Information

Preference and Gala Information

Payment