Membership « New Mexico Hispanic Medical Association

Membership

Current and prospective members can renew or become members by filling out the form below. Membership will provide you with free CME at our annual conference scheduled for August 21, 2010 at Isleta Conference Center. 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"

YES, I want to become a member

YES, I want to renew my membership

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) NATIONAL HISPANIC MEDICAL ASSOCIATION:

The NMHMA encourages membership in the National Hispanic Medical Association. We strongly believe that many of the issues we face in New Mexico require national attention in order to be addressed. Therefore, we offer a joint membership at a discounted rate. For information, please go to nhmamd.org

National Hispanic Medical Association - $150

NMHMA - $100

Combined Discounted Membership - $200

Savings $50

YES, Please sign me up for a combined membership at the discounted rate of $200
(Note: The NMHMA will forward your membership to the National Hispanic Medical Association)

4) 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.)