PSAA

To join PSAA, you must first send in a completed application with your membership dues. To join PSAA you can either fill out this form and submit, you will then be redirected to a secure site where you can pay by credit card. Or, if you'd rather send a check, please print out this page, complete the application and mail it in with your payment.

A membership in PSAA belongs to the practice; however, please fill in the name of your office administrator or manager who will be representing your practice. This membership is transferable in the event of staffing changes.

MANAGER'S NAME (LAST, FIRST, MIDDLE)

PRACTICE OR PHYSICIAN EMPLOYER'S NAME

MAILING ADDRESS

CITY

STATE

ZIP CODE

OFFICE TELEPHONE

OFFICE FAX

HOME TELEPHONE (OPTIONAL)

E-MAIL ADDRESS

REFERRED BY

MEMBERSHIP RENEWAL
NEW MEMBERSHIP

Before submitting this form, please print out this page and mail it to the PSAA address below.

Before applying for membership, I would like more information. I may be reached at the above address.

Membership Dues:
Annual Membership Dues - $150

Mail application and check to:
PSAA
6324 Fairview Ave N
Crystal, MN 55428

For more information on PSAA, please call 800.373.0302.
Or, click here to join PSAA.