AAOCFM Membership Application

Fill out the form below to become a member:
Membership application fee $300
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Is your license in effect and unrestricted yes no
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List accredited cosmetic workshop(s) and dates attended  
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By clicking the submit button below, I agree that membership in the American Academy of Cosmetic Family Medicine (AAOCFM) is a privilege not a right. I recognize that the contents of this application will be seen by individuals working for AAOCFM. I agree to surrender my membership and return my certificate if my license to practice medicine is revoked, suspended or limited beyond its present state, or if membership is revoked or terminated for such other cause as may be provided by the bylaws of the Society. Moreover, I acknowledge that membership in AAOCFM does not qualify me as a certified physician to practice cosmetic procedures, and that membership alone in said Society is for educational purposes to advance knowledge and experience. Additionally, I agree to adhere to all rules regulations and policies as adopted by AAOCFM. I furthermore understand that membership in AAOCFM does not give me license to perform cosmetic procedures. Instead, it expresses my interest and participation in the studying of techniques. I hereby acknowledge and authorize use of the information I have provided for dissemination of information from or approved by AAOCFM which it deems germane to my practice.
 
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Download the AAOCFM Membership Application and fax to 520.545.1254
if paying by check, mail completed form with check to:
FAME (Foundation for the Advancement of Medical Education)
8000 S Kolb Rd, Ste 102
Tucson, AZ 85706