Membership Checkout – CENTRAL FLORIDA ASSOCIATION OF PHYSICIAN FROM THE INDIAN SUBCONTINENT

Membership Information

You have selected the Joint Annual (5-year pre-pay) membership level.

Joint 5-year prepaid membership for two members with full member benefits.

The price for membership is $900.00.

Membership expires after 5 Years.

Do you have a discount code?

Account Information

Username

Password

Confirm Password

Hint: The password should be at least twelve characters long. To make it stronger, use upper and lower case letters, numbers, and symbols like ! " ? $ % ^ & ).

Email Address

Confirm Email Address

Full Name LEAVE THIS BLANK

Already have an account? Log in here

PERSONAL INFORMATION

First Name

Last Name

Gender

Male

Female

Cell Phone

Home Address

Address Line 2

City

State

Zip

PROFESSIONAL INFORMATION

Primary Specialty

NPI Number

Practice Type

Website

Hospital Affiliation 1

Hospital Affiliation 2

Detailed Bio

CAPI INVOLVEMENT

Do you have an interest in

Volunteer Activities

Leadership Development

Committee Participation

MEMBER DIRECTORY (shared with members only)

Do not show my Cell Phone Number
Do not show my Email Address

JOINT MEMBER INFORMATION

First Name

Last Name

Group Account Information

This purchase includes 1 additional seat.

Group members will be able to claim the Joint Secondary Member membership level.

Billing Address

First Name

Last Name

Address 1

Address 2

City

State

Postal Code

Country

Phone

Processing...

Membership Information

Account Information

PERSONAL INFORMATION

PROFESSIONAL INFORMATION

CAPI INVOLVEMENT

MEMBER DIRECTORY (shared with members only)

JOINT MEMBER INFORMATION

Group Account Information

Billing Address

Main Links

Quick Links

Find us Elsewhere