ACOEP Life Member Application

Life Member Application

Complete the application below to apply for Life Membership
Thank you for applying for Life Membership. With Life Membership, you will no longer be required to pay membership dues, but would be able to vote in college elections. Please complete the application below to determine that the criteria apply to you. Please note: Life Membership rates go into effect during the next dues cycle after granting of this status.
Applicant's Full Name*

First NameLast Name
Email*
example@example.com
Date of Birth*
Life Membership status may be granted to any ACOEP member upon applications to the Member Services Committee who meets the following criteria:

(1) Twenty-five (25) years of continuous, active membership in the College and has reached the federally defined retirement age;

(2) Permanently retired or disabled physician with a minimum of twenty (20) years of continuous, Active membership in the College prior to being designated a Retired member, and a minimum of five (5) years

(3) Sixty (60) years of age (or older), active member of the College for at least ten (10)
Please acknowledge that the criteria above that are met:*

At least 60 years of ageFully retired or disabled physicianReached the federally defined retirement age (67)25 years of continuous, active membership with ACOEP20 years of continuous, active membership with ACOEP10 years of continuous, active membership with ACOEP
ACOEP Membership Join date: *
Date of Retirement
Anything else the Membership Committee should know?
This certifies that the information contained in this application is the most accurate information available. Additionally, with my signature, I verify that I have met the criteria defined in the Bylaws of the American College of Osteopathic Emergency Physicians regarding obtaining sufficient CME credit required for Emergency Medicine specialists
Signature*

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Date*

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Date
Applications must be received at least (30) days prior to the next scheduled Committee meeting in order to be considered at the upcoming Spring Seminar or Scientific Assembly. You will be notified within (60) days of the Committee review of your member status. Any further questions or concerns, please contact us at info@acoep.org.
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