2025 VASM Membership Registration Form

Membership Application / Renewal

2025 Membership Form
Name*

First NameMiddle NameLast NameDegree
Practice Address:*

Practice Name

Street Address

CityState / Province

Postal / Zip CodeCountry
Home Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
Phone Number:*

Area CodePhone Number
Cell Phone:

Area CodePhone Number
Are you interested in serving on the VASM Board or one of our Committees?

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My Products*
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Membership Dues | Doctoral Level$120.00
Physician / Dentist Membership (MD, DO, PhD, DDS, DMD)

Quantity

Membership Dues | Allied Sleep$65.00
Allied Sleep Professional Membership (RPSGT, PA, NP)

Quantity

Membership Dues | Affiliate Member$65.00
Affiliate Membership (sleep center managers, RRT with certification, dental staff)

Quantity

Membership Dues | Trainee$35.00
Students & Resident Membership dues

Quantity

Total $0.00
If paying for multiple memberships, please list out the names here:

Payment Methods

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Choose from one of the PayPal options to make your payment.

Membership Application / Renewal