Group Annual Membership Registration Form

IMPORTANT REQUIREMENT!!

ALL MEMBERS OF YOUR PRACTICE GROUP MUST SUBMIT DUES IN ORDER TO RECEIVE THE DISCOUNTED PRICE. YOU MUST ALSO USE THE AOS GROUP ANNUAL MEMBERSHIP TEMPLATE (EXCEL SPREADSHEET FOUND ON THE WEBSITE UNDER GROUPS AND ALSO BELOW) WHEN UPLOADING THE LIST OF PHYSICIANS.
I understand the requirements
Click here to download AOS Group Annual Membership Template
CONTACT INFORMATION
First Name*
Last Name*
Practice Name*
Practice Address*

Street Address

Stre

CityState

Zip Code
Practice Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Practice Email*
example@example.com
Website*
Practice ManagerBusiness ManagerOffice ManagerOther
PHYSICIANS INFORMATION
Attach Excel spreadsheet with list of all physician's information here. You must use the AOS Group Annual Membership Template found on the website. *

Acceptable file types: .XLS, .XLSX or .CSV only
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Total number of physicians listed on Excel spreadsheet*
PAYMENT REGISTRATION INFORMATION

In order for your submission to be approved and your payment to be processed, the Quantity entered in the payment field below must match the total number of physicians entered above AS WELL AS the total number of physicians listed on the Excel spreadsheet. All three must match or your payment will be denied and a new form will have to be submitted again. Also, Please note that all credit card transactions will incur a 3.5% administrative charge.

IMPORTANT REQUIREMENT!!