UAPD Private Practice Membership Application

AFSCME Local 206
Affiliated with the AFL-CIO

1-800-622-0909

Dues for private practice members are set at $440 per year and can be paid by credit card below.

Name*
First Last
Degree
Workplace
Email*
Address
Street Address City State / Province / Region ZIP / Postal Code
Are you interested in learning more about UAPD's Independent Physician Association (IPA)?
- Yes
- No
Annual Private Practice Dues*
Price: $440.00 Quantity:
Your dues payment will renew annually. You can call 1-800-622-0909 to cancel your membership.
Total
$0.00
Credit Card*

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name