SurveyMonkey Powered Online Survey

This short questionnaire will take fewer than five minutes and will enable you to select the email address you want to use for your MyAANP login. The details you provide will help us seamlessly combine any information from previous AANP memberships or logins with your new AANP membership provided by Optum.

Question Title

* 1. Contact Information

First Name *

Last Name

Home Address

Home Address 2

Home City/Town

Home State/Province

Home ZIP/Postal Code

Optum Email Address *

Phone Number *

Question Title

* 2. Please select all that apply:

I am currently (or have previously been) an AANP member, not including my new membership from Optum.

Prior to receiving an AANP membership from Optum, I created a username and password for the AANP website.

I would like to use an email address other than my Optum address as the username for my AANP account.