ACP Reinstatement Form For Members, Fellows and Physician Affiliates

* Required field

Contact Information
Recruiting Information
Annual Dues
To Ensure Membership through June 30, 2017 [i]
Priority codes allow us to administer special offers, discounts, and help us determine which of our products and services are of most value to you. Priority codes are listed on ACP print promotions and some electronic promotions. The priority code is indicated clearly within written text or on the mailing panels of most forms near the ordering information. Entering a priority code will help us meet your future needs.
[i] Membership dues rates are pro-rated throughout the membership year. The dues you are charged will be contingent upon the month you reinstate. The allocation of chapter dues is waived for newly reinstated members. Upon membership renewal, annual dues will include fees to support both the national ACP and your local chapter. For the renewal dues rate in your chapter, please visit https://www.acponline.org/dues. [ii] Physicians outside of the United States should contact ACP Member and Customer Service for reinstatement rate options.
Agreement
*If you have been subject to disciplinary action, please contact Member Credentialing at 800-523-1546, extension 2704 or 215-351-2704 or by email at custserv@acponline.org.
Payment Details
Once you submit this form, ACP Member and Customer Service staff will contact you by email to complete your request and to process your membership dues payment.