Confidential Request for Dues Adjustment

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Please complete the below form to request a dues adjustment consideration. To be eligible for a dues adjustment , you must be a post-training physician within the United States. As global dues rates are already discounted, these rates are not eligible for a dues adjustment.

Please remember to print a copy of this form for your records.

Please indicate the type of dues adjustment being requested:
Dues Adjustment Type:

I have a medical condition that seriously interferes with the ability to practice medicine and/or earn income.

I am experiencing a sudden, unforeseen short-term financial difficulty resulting in substantial reduction of income.

Please select the category of financial hardship for which you are applying.
You must provide additional information below.
Condition Type
Employment Type

One file only.
100 MB limit.
Allowed types: jpg, jpeg, pdf, doc, docx.

You must provide additional information below.
You must provide additional information below.
Dues Type

ACP reserves the right to alter its dues adjustment policy and criteria at any time, including the removal or change in rate of a temporary or permanent dues reduction or dues waiver. Information provided will be considered confidential. Please allow up to 90 days for review and notification of decision.

Questions: Contact us (M–F, 9 a.m.–5 p.m. ET) 800-ACP-1915 (800-227-1915), or direct at 215-351-2600.