Membership Application

Membership Level:

Physician $175 (USD)

Medical Resident or Medical Fellow $125 (USD)

Non-physician $100 (USD)

Student $25 (USD)

(*Must include a copy of current and valid student ID.)

Send copy of student ID to info@nasrhp.org

First Name: Last Name: Email: City: (optional) State: (optional) How many refugee patients do you typically serve in a year? Are you a previously resettled refugee? (this information will not be shared, we just want to how inclusive our membership is.)

Please create a login name and password below. Your password must be at least eight characters long, and contain at least one number.

Create a Login Name: Password: Retype Password: