AAPL Membership Application: (*) Application Type:   New Member (*) First Name:   Middle Name/Initial:   (*) Last Name:   Degrees (RN, MSW, etc.):   (*) E-mail:   Title:   (*) Organization:   Department:   (*) Street:   Suite:   (*) City, State Zip:  ,    (*) Phone:   Fax:   Check all that apply to your organization:  Academic Medical Center  Not-for-Profit  Teaching Hospital  For-Profit  General Acute Care  Specialty Hospital  (specify specialty):   Interested in serving on:  Board of Directors  Committee     (specify): Topics/speakers of interest for conferences: