Membership Dues Waiver

Membership Dues Waiver Application

The following options are available for active members to request a waiver of their membership dues pending approval from the ACOFP Membership Committee and ACOFP Board of Governors:

Life Membership

Life membership is available for active members who have reached the age of 70 years, or who have completed 50 years in practice of osteopathic family medicine, whichever comes first, and who has been a member in good standing for 25 consecutive years immediately preceding. Life members do not pay dues and have voting privileges.

Financial Hardship

Financial hardship one-year membership waivers are available for active physician members earning minimum to no income from the practice of medicine, whereas those completely out of practice may have their dues permanently waived. Waivers are granted on a case-by-case basis. The following supporting documentation must be submitted prior to reviewing all requests: a personal letter describing the reason for the request and a copy of the most recent tax return.

Maternity or Paternity

Maternity or paternity one-year membership waivers must be filed as a financial hardship. All financial waivers must meet the following requirements: The following supporting documentation must be submitted prior to reviewing all requests: a personal letter describing the reason for the request and a copy of the most recent tax return. If the member is applying for additional years after the initial approval, a copy of their spouse’s tax return must be submitted if they are not jointly filed.

Medical Disability

Medical Disability one-year membership waivers are available for physician members earning minimum to no income from the practice of medicine, whereas members completely out of practice may have their dues permanently waived. Waivers are granted on a case-by-case basis. The following supporting documentation must be submitted prior to reviewing all requests: a personal letter describing the reason for the request and A letter from your physician supporting your medical disability request.

Type of waiver I am applying for: ^*

Name

Credentials (ex.: DO, MD, MPH, etc.)^*

AOA ID Number

Mailing Address

Area code and Phone Number^*

Email Address^*

How many years have you been an ACOFP member?^*

Please indicate the status of your practice and/or your professional employment. ^*

Please indicate how many hours per week you are currently working. ^*

Have you received a reduction or waiver of membership dues from the AOA? ^*

Have you received a reduction or waiver of membership dues from your state or affiliate association? ^*

Supporting Documentation

If applying for a financial hardship waiter, please upload a letter stating the reason for the request.

Copy and paste your letter here, if you do not upload.

Letter from Physician (Medical Request Only)

Copy and paste your letter here, if you do not upload.

Most Recent Tax Forms or Proof of Income (Financial and Maternity/Paternity Requests Only) *This field is not required for those applying for life membership.

By clicking Submit below, I certify that the above information is correct and complete and do hereby agree by the Constitution and Bylaws of the American College of Osteopathic Family Physicians. I agree to accept the Board of Governors of the ACOFP as the sole and only judge of my qualifications to be and remain a member.