Physician Assistant Membership Application

Sign Up For Your TGCPAA Account
  - Required Field
SECURITY
   
     
     
  (e.g. What is the model of your first car?)
   
  (e.g. Camry)
PERSONAL
Last Name    
First Name    
Home Address    
City    
State    
Postal Code    
Home Phone    
Mobile Phone  
 
PROFESSIONAL  
Designation    
Graduate PA Program
Graduate PA Year   
PA License No
 
EMPLOYMENT
Employment Status    
Type of Practice
Institution
Work Address
City
State
Postal Code  
Phone  
Extension    
Fax  
 
MEMBERSHIP
Type    
Payment Method    
   
Do you want to receive job announcements?
Preferred Mailing Address
Are you interested in student shadowing?
Are you interested in mentoring a PA student?
Do you participate in social networking sites such as Facebook?
Please select ALL TGCPAA committee you are interested in being involved in:
Please select ALL leadership positions you would be interested in:
 
Comments
 

Once your application has been verified, you will receive a welcome email and link for payment of membership dues.
After your membership dues are paid, you will receive TGCPAA correspondence and meeting invitations at the email
you have in your online profile. Membership benefits include access to the TGCPAA membership directory and your
personal CME transcript. These items can be accessed by logging into your TGCPAA account.

Please remember that TGCPAA does not have a Pre-PA shadow program. Only PA students in an accredited program
can apply for membership .