Membership Application - American Society of Medical Association Counsel

ASMAC MEMBERSHIP APPLICATION

Thank you for your interest in ASMAC. Please review the membership criteria. If you are not directly employed by a medical society or association, you will need to obtain sponsorship and submit the completed form with this application. You may contact our office for assistance or additional information.

Download Sponsorship Form | ASMAC Bylaws

Attorney Information

Name *

First

Last

Today's Date *

Email *

Phone *

Society or Firm Name *

Position Title *

Mailing Address *

Address Line 1

Address Line 2

City

State

Zip Code

Membership Categories: *

Regular Membership - $ 220.00
Group Membership - $ 145.00
Emeritus Membership - $ 100.00

Note: Group Membership dues are reduced for 3rd and subsequent qualifying members from the same organization. | Emeritus dues are for a 2-year period.

Membership Attestation and Payment

Membership in ASMAC is limited to persons who are attorneys currently admitted to practice before the highest court of any state and are substantially engaged in the service of a county, state or national medical association. (See ASMAC bylaws for clarification) *

By signing below, I attest that I am eligible under the ASMAC bylaws for membership.

Signature *

Total Amount Due *

$ 0.00