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Private Practice Member Application
Dues for private practice members are set at $440 per year and can be paid by credit card below.
Private practice membership is currently available to doctors practicing or residing within the state of California.
Name
*
First
Last
Degree
Workplace
Email
*
Address
Street Address
City
State / Province / Region
ZIP / Postal Code
Annual Membership Fee
*
$440
Credit Card
*
Card Details
Cardholder Name
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3
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