Active Membership Application and Renewal Form

Member Type

*If you are a TPS member in your first year post-residency, please contact the Membership Services manager, Crystal Healey or call her at (512) 370-1517.

Total Amount
Please enter a Username to create an account. If you already have an account please login before completing this form.
Membership Profile for Active Member Type
If you have a different preferred first name, please let us know what you want to go by here.
In the next field, enter any additional academic accreditations. Such as: MPH, MBA, PhD, FAAP, etc. Please type in all CAPS, and no periods.
This field is not required, only if you wish to provide it.
 
 
If an exact date is unknown, please choose any day in the closest month and year.
If an exact date is unknown, please choose any day in the closest month and year.
If an exact date is unknown, please choose any day in the closest month and year.
 
Credit Card Information
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Billing Name and Address
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