2026 AVAA Membership Application

2026 AVAA Membership Application
Name

First NameLast Name
Degree (MD, PhD, etc.)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
VA Email Address
example@example.com
Personal Email Address
example@example.com
VA Medical Facility Affiliation
VISN
Please indicate your profession:
Membership dues are charged on an annual calendar basis.

Medical students/residents/fellows are exempted from payment.

Once completed, you will receive an email with a link to your invoice for payment. Please allow up to 48 hours to receive this email from ASA.
Should be Empty: