AAMA Join Application

EVALUATION APPLICATION
Name Name First Last
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Business Address (put "Same" if not different)
Home Phone
Minimum of 5 characters required. Currently Entered: 0 characters.
Office Phone
Minimum of 5 characters required. Currently Entered: 0 characters.
Referral Phone
Minimum of 5 characters required. Currently Entered: 0 characters.
Email
Web Site
Date of Birth
SSN (Last 4 digits)
Sex

Sex Male Female
State/Country practicing or plan to practice
DOCTORATE EDUCATION/TRAINING
School
Certificate or Degree
Certificate or Degree Date Certificate or Degree Date / MM / DD YYYY
Certificate/Degree
COLLEGE EDUCATION
Name
Degree(s)
Graduation Date Graduation Date / MM / DD YYYY
College 2 Name
Degree(s) 2
Graduation Date 2 Graduation Date 2 / MM / DD YYYY
Certification & Application Fee of $335.00 (U.S. Funds)

Application processing fee of $25.00 (non-refundable)
Certification fee of $310.00 (refundable if not certified)
Upload a copy of Drivers License or Passport

Attach Files
Upload a copy of Doctorate Degree Certificate (Can Upload Multiple Files)

Attach Files
Upload a copy of College Degree (Can Upload Multiple Files)

Attach Files
I understand that laws may vary from one state to another. If certified, I will become aware of, and abide by, any and all state regulations.

I certify that all statements and information provided herein are true and accurate.
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