Membership Application

Please download, print, and mail, email or fax the membership application to:


Michael Brandler, MD

Membership Chair

NYPQ

Main Street

Flushing, NY 11355

Fax: (718) 661 - 7120

email: mdb9011@nyp.org


or


Samuel Bangug, MD

President

170 - 13 Hillside Ave

Jamaica, NY 11432

Fax: (718) 657 - 2420

email: bangug908@yahoo.com

QPS membership form (doc)

Download

Pay Membership Fee

$150.00

Pay with PayPal or a debit/credit card

Click "Pay Now" to pay your membership dues securely using a Credit Card or PayPal Account.