Virginia Chapter, American Academy of Pediatrics and the Virginia Pediatric Society 2201 West Broad Street, Suite 205 Richmond, VA 23220 Phone: (804) 643-6631 Fax: (804) 788-9987 Email: jdavis@ramdocs.org Please submit the following application to apply online for membership. Mail your dues payment with a note indicating that you have applied online. Make checks payable to AAP. Full Name: Practice Name: Subspecialty: Preferred Mailing Address:   Office     Home  Office Phone: Fax: Home Phone: E-mail Address: Office / Practice Manager: Sex:   Male     Female  Date of Birth: Spouse's Name: Please check membership category. Chapter Fellow (Current Fellow of the American Academy of Pediatrics) $175 Member, Virginia Pediatric Society (Not a Fellow of the AAP but pediatric trained and practicing pediatrics in Virginia) $175 Married Fellow (Both spouses are Chapter or Society members) $100 Affiliate Member (Physicians or dentists practicing in other specialties relating to pediatrics) $175 Candidate (Limited to four years after completing PL-3 training) $100 Resident  PL1   PL2   PL3   (Physicians in primary pediatrics specialty training) $0 Allied Health Professional (Licensed pediatric nurse practitioners and physician assistants) $75 Practice Manager (Managing pediatric practice of a Chapter/Society member in Virginia) $75 Mail your dues payment with a note indicating that you have applied online. Make checks payable to AAP. Virginia Chapter, American Academy of Pediatrics and the Virginia Pediatric Society 2201 West Broad Street, Suite 205 Richmond, VA 23220 Phone: (804) 643-6631 Fax: (804) 788-9987 Email: jdavis@ramdocs.org