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

Name *

First

Last

Credentials (ie. J.D., LL.M., J.S.D., J.S.D., etc. ) * *

Username *

Email *

Password *

Today's Date *

Contact Information

Organization Name (society, firm or school) *

Position or Job Title *

Address *

City *

State *

Zip Code *

Phone *

Membership Information

Membership Category (select one) *

Note: Attorney discount membership available to 3rd and members from the same organization.

Attestation: I have read the membership criteria and verify that I meet the membership criteria selected below. (See ASMAC bylaws for clarification) *

I am an attorney employed by a state or national medical society.
I am a healthcare attorney substantially engaged in the service of a county, state or national medical society.
I am a non-attorney employed by a state or national medical society.
I am currently a law student interested in health law.
Other (please describe below)

Questions or Comments

Feel free to share a little information about how you heard about ASMAC or why you are interested in becoming a member.