MEMBERSHIP APPLICATION FOR COLLEGIUM AESCULAPIUM FOUNDATION
Step 1: Classification & Annual Dues
Practicing Health Professional
$250.00
New Member Application Fee 
$0.00
Donation: Nurses Kits/Merck Manuals for LDS Medical Missionaries 
$
Donation: Collegium Association Support to help with office supplies, travel and association needs. 
$


Health Professional Resident

$50.00
New Member Application Fee 
$0.00
Donation: Nurses Kits for LDS health missionaries 
$
Donation: Collegium Association Support to help with office supplies, travel and association needs 
$


1st/2nd Year Practicing Health Professional

$75.00
New Member Application Fee 
$0.00
Collegium Aesculapium Support 
$0.00
Humanitarian Aid 
$0.00


Retired Health Professional

$125.00
New Member Application Fee 
$0.00
Donation: Nurses Kits for LDS Health Missionaries 
$
Donation: Collegium Association Support to help with office supplies, travel and association needs. 
$


Associated Professional - Nurse, Educator, Pharmacist, etc

$125.00
New Member Application Fee 
$0.00
Donation: Nurses Kits for LDS Health Missionaries 
$
Donation: Collegium Association Support to help with office supplies, travel and association needs. 
$


Health Pre-Profession Student

$25.00
New Member Application Fee 
$0.00
Donation: Nurses Kits for LDS Health Missionaries 
$
Donation: Collegium Association Support to help with office supplies, travel and association needs 
$
 
 
Total: $250.00
Payment Method

Pay Online
Print Statement & Send Via Mail

Application Progress

1: Classification
2: Contact Information
3: Verify Information
4: Submit Application

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