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Member Contact Update Form
Change in your email address? Your address? Your phone? Let us know!

Please note, if you leave a box blank, we will assume that information is unchanged. In addition, we will also send your information to the AAFP so your member record with them is also up to date.

Email Policy
The PAFP only emails members who provide their email addresses. Thank you for helping to keep our records up-to-date.

Privacy Policy
The PAFP does not share your email address with outside entities, and we have no plans to do so in the future. Please be aware that the PAFP tracks email so that we can provide more efficient, more personalized member service. If, at any time, you decide you no longer wish to receive email messages, contact us at and your member record will be updated immediately. Read the complete privacy policy.

Email Frequency
If you are registering to receive email for the first time, you can expect about five emails/month, including the Member News Flash (in the month after Keystone Physician is published), updates/alerts on public policy issues, notices on upcoming CME, plus information on special offers just for PAFP members.
Personal Information
AAFP/PAFP Member ID No.:
First Name:
Middle Name:
Last Name:
Changing Last Name, What Was Your Old Last Name:
Office Information
Practice Name:
Practice Street Address:
Practice City, State Zip Code:
Office Phone No.:
Office Fax No.:
Home Information
Home Street Address:
Home City, State Zip Code:
Home Phone No.:
Additional Information
Preferred Email Address:
Preferred Mailing Address:

© Copyright 2011-2016, Pennsylvania Academy of Family Physicians and Foundation. All rights are reserved.
2704 Commerce Drive, Harrisburg, PA 17110
Toll Free: (800) 648-5623 Phone: (717) 564-5365 Fax: (717) 564-4235

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