Michigan Academy of Family Physicians
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Request for Membership Application

View Membership Classifications Chart. (2 pages/534 KB. More about PDFs.)

Please complete the following form. Upon receipt of the form, an application will be forwarded to you in the mail. Questions on completing the application should be directed to Trisha Marsh marsht@mafp.com at MAFP Headquarters.

First Name
Middle Initial
Last Name
Address
Address 2
City
State
Zip Code
Work Phone
Home Phone
Pager/Voice Mail
Email

2164 Commons Parkway
Okemos, MI 48864
Ph: 517-347-0098 or 800-833-5151
Fax: 517-347-1289
info@mafp.com
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