Performing Arts Medicine Association

Personal Information

First Name *

Last Name *

To which gender identity do you most identify? *

Which pronouns do you prefer? *

Primary Degree

Additional Degree(s)

Advanced Certification

Email Address *

cc: Email Address

Professional Specialty

(e.g., Neurology, Violin Teacher)

Arts Medicine Focus

(e.g., Stage Fright, Ergonomics)

Company/Organization

Title

Membership Type

Select your membership type: (The student/resident category will not have voting privileges)

Cost:

Physicians (MD, DO), Chiropractors, Dentists - $250 US
Allied Healthcare - $195 US
Performing Artist - $175 US
Retiree (Continuous PAMA member for the past 5+ years required) - $65 US
Students and Residents (Full-time) - $65 US

Students (* Click Here to Expand for Required Information)

Students Only

Students ONLY

To qualify for the student membership level, you MUST complete the following information:

* Academic Program

* Academic Institution

* Current Credit Hours

* Expected Graduation Date

Month

Day

Year

Students Only

Retirees (* Click Here to Expand for Required Information)

* If you selected the Retiree category you must select how long you have been a continuous PAMA member:

5-7 years

8-10 years

11+ years

* Proof of Retirement Status

Member Directory Listing

Address Line 1 *

Address Line 2

City *

State/Province (USA/Canada only)

State/Location (rest of world)

Zip/Postal Code *

Country *

Phone

If you do NOT want to be listed in the Member Directory (accessible ONLY to members), please check this box

Do not list me in the member directory

Membership Questions

Are you a new PAMA Member? *

Yes

This information is used by PAMA to select member interest groups when working on a specific project. Please select one primary and (if applicable) one secondary PAM area of focus from the following lists. Note: This is not a factor in getting referrals which relies on geographical location.

Are you active in PAM research?

Yes, I am active in performing arts medicine research

Answering this question will help you connect with others who are active in PAM research

Referrals Database

Would you, your clinic, or practice like to be listed on the PAMA website so that patients and other professionals can find you for referrals or as a resource? Here is your opportunity! By giving your contact information below, you are giving PAMA approval to list you on the PUBLIC side of the PAMA web site with a URL web address and/or e-mail address along with your name plus city, state/country, specialty, and focus. Note: If your website is for an organization and your name is not readily found, it is best to add your email address so that you can be reached directly.

To be listed in the referrals database, you MUST provide at least one of the items below (website, email address, and/or a phone number). If no information is provided below, you will NOT be listed.

Would you like to be listed in the PAMA Referral Database? *

Yes, list me in the Referrals Database

No, do NOT list me in the Referrals Database

If yes, you MUST enter information in at least one of the fields below:

Your Website Address (only one). Include the leading http:// or https://

and/or the E-mail Address to be Listed

If you would like a phone number to be listed, enter it here

Optional Automatic Membership Renewal

You can now put your PAMA membership on cruise control by selecting automatic membership renewal with recurring billing. This is a great way to ensure your membership does not lapse. We will email you during the month prior to your automatic renewal to let you know when the renewal will occur. You can cancel automatic renewal at anytime. This feature is optional. To start automatic renewal, please check the acknowledgement below.

Optional Automatic Membership Renewal

I authorize PAMA to enroll me in automatic membership renewal using recurring billing on a yearly cycle.

STOP! Please take a moment to review your answers to ensure accuracy.

Then click "SUBMIT FORM" to be taken to the payment screen. If you wish to cancel this submission and not continue, simply close this window.

(If you're a human, don't change the following field)

Enter your name

Your first name.

(If you're a human, don't change the following field)

Enter your name

Your first name.

Enrollment Form

Personal Information

Membership Type

Students ONLY

Member Directory Listing

Membership Questions

Referrals Database

Optional Automatic Membership Renewal

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