Membership Application 2018-05-09T22:20:10+00:00

Current benefits of membership include:

Listing on our website’s provider directory.  Physician memberships only.  2 locations per physician level membership.  More than 2 requires additional fees.  Contact us for details

Discount to annual scientific conference (Spring 2018).

Quarterly webinar for member Q&A.

On-line, closed forum for practitioners to discuss issues relevant to the clinical use of ketamine.  Once your membership is approved, and payment for your dues has been received, you will be contacted by ASKP with your username and password for accessing the forum.  If you are an active member, and have not received your user name and password, please contact us at info@askp.org for assistance.

Thank you again for your interest in joining our society. Your application is subject to approval. We reserve the right to decline your membership.

Membership Application

    *membership rates are subject to change & for questions regarding membership category, please contact us at info@askp.org
  • $0.00
  • For physicians only. This number will used for verification purposes by ASKP personnel. It will not be posted publicly.
  • This is the number that will be posted on the clinic directory, if applicable.
  • This number will used by ASKP personnel for membership issues. It will not be posted publicly. It may or may not be the same as the clinic phone number (above). This is a required field.
  • This is the email that will be listed on the store locator, if applicable.
  • This email will be used by ASKP personnel for membership issues, and will not be posted publicly, on the clinic directory, or otherwise. It is mandatory.
  • This field is for validation purposes and should be left unchanged.