Active Membership Application and Renewal Form

Member Type

*If you are a TPS member in your first year post-residency, please contact the TPS Director of Member Services Crystal Healey via email at crystal.healey@txpeds.org 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.
 
Please enter a brief description of how you heard about TPS, or if a colleague referred you to us.
This information will remain confidential and will be used to serve members.
Credit Card Information
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Billing Name and Address
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