Company Membership Application

Instructions for residency membership rates:

  1. Fill out the application form for your residency program.
  2. Pay now or send a check at a later date.
  3. Email the info@academicpeds.org a list of your residents to be added to this account.
    1. Send the name of the account.
    2. Send an excel spreadsheet of residents with the below information:
  1. First Name
  2. Last Name
  3. Degree(s)
  4. Email Address
  5. Address
  6. Phone
  7. Residency Year (PGY1, PGY2, PGY3, or chief resident)
  8. DOB
  9. Gender
  10. Program Name/Medical School Affiliation

*Please allow a week for processing. An email will be sent to you once this is complete.

-
If you would like to manage your Neon CRM account (i.e., view donation history, renew membership, etc.), please create a login name and password below. Your password must be at least eight characters long, and contain at least one number.