Thank you for your interest in AMSA, the only national independent student-run medical organization working for the medical student. To join, simply print this application and present it, with payment, to an AMSA officer on campus.
AMSA membership entitles students to benefits and services offered through the AMSA national organization.
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The HubPLEASE TYPE OR PRINT CLEARLY
Name, First ______________ M.I. ___ Last __________________
Street Address _____________________________ Apt/Room ___
City, State, Zip _________________________________________
Phone Number _______________ Email _____________________
Social Security No. ____________Gender ____ Date of Birth _____
School Nova Southeastern University College of Osteopathic Medicine
Anticipated Graduation Date _____________
AMSA members are entitled to receive The New Physician (TNP) magazine, published nine times a year. Indicate if you wish to receive the magazine:
__ YES, send me TNP __ NO, do not send me TNP
If made available, would you wish to receive The New Physician in electronic format ONLY as an alternative to the printed format?
__ YES __ NO
STANDING COMMITTEES: As an AMSA member, you are automatically a member of the Standing Committees (SCs) on Community and Public Health, Global Health Action, Health Policy and Medical Education. Find out more about these groups by visiting the SC Web pages at http://www.amsa.org/member//sc/sc.html. The fifth SC is the Advocacy, consisting of four individual groups. Please indicate below which groups, if any, you wish to join:
- ___ Lesbian, Gay & Bisexual People in Medicine (LGBPM)*
- ___ Disabilities*
- ___ Minority Affairs
- ___ Women in Medicine
- ___ Disabilities*
* LGBPM and Disabilities member lists are kept confidential. If you prefer to join these groups by phone, call 800-767-2266.
INTEREST GROUPS:
Our Interest Groups (IGs) can be found on AMSA's IG pages. These groups maintain listservs to help you stay in touch with others who share your interests. Current IGs are Bioethics, Child & Adolescent Health, Death & Dying, Humanistic Medicine, Primary Care and Research in Medicine.
DUES AND FEES
Pays for membership in both the national organization and the local chapter.First-year student: $75 for up to 5 years of medical school*
Second-year student: $70 for up to 4 years of medical school
FORM OF PAYMENT
We request that payment be made by check, as the local chapter cannot process credit cards. Please make checks payable to AMSA.Signature ____________________________________ Date ______
Information received from this application may be used for the promotion of educational products and/or other services that directly benefit physicians-in-training. Promotions are approved by AMSA's board of trustees. If you do not wish for your name to be used in such mailings, please indicate.
- ___ Do not release my name for any promotions.
- ___ Do not release my e-mail address for any listserve promotions.
- ___ Do not release my phone number for any promotions.
- ___ Do not release my e-mail address for any listserve promotions.
MEMBERSHIP DUES ARE NOT REFUNDABLE.
Dues/contributions/gifts to AMSA are not deductible as charitable contributions for federal tax purposes. However, dues may be deductible by members as an ordinary and necessary business expense. Please consult your tax adviser.
Questions? Contact your local chapter officers or call the national organization at 1-800-767-2266