Membership

Current and prospective members can renew or become members by filling out the form below. Membership will provide you with free registration at our annual CME Conference Perspectives in Minority Health scheduled for August 2014. Your membership dues also contribute to the charitable activities of the NMHMA.




Membership Application / Renewal Form

"You do not have to be Hispanic to become a member"



1) PERSONAL INFORMATION:

* Required

* Name:

Title:

Medical School Attended:

Residency:

Subspecialty:

Business Phone:

Business Fax:

* Email:

* Address:

* City:

* State:

* Zip:



2) MEMBERSHIP CATEGORIES:


Regular Members

Associate Members

Physicians - $100

Residents - $25

Physician Assistants - $35

Medical Students - FREE

Nurse Practitioners - $35

Other Students - FREE



3) COMMITTEE INTEREST:


Please check committees you may be interested in serving on (NMHMA only).

Conference Committee

Fundraising Committee

Legislative Committee

Scholarship Committee

Newsletter Committee

Membership Committee






(Note: Upon clicking submit you will be re-directed to Paypal to accept and process your payment, unless your membership type is FREE.)