Mid-South Medical Group Management Association Application

 

Membership is contingent upon approval of the MSMGMA Board of Directors.

 

 

New Member
Returning Member

 

Membership Type

Active Membership Dues $250 (After 2/28/11 $300)
Affiliate Membership Dues $300 (After 2/28/11 $350)

 

Active Member: one actively engaged as an administrative head or full-time administrative staff member of one of the following types of organization:

1. Medical group practice of physicians formally organized for the purpose of health care delivery.
2. Organizations that provide physician-directed health care services.

Affiliate Member: one who provides products and/or services to the healthcare industry.

 

Name

 

Title

 

Organization Name

 

Mailing Address

 

City

 

State

 

Zip

 

Phone

 

Fax

 

Email

 

Referred By

 

 

We Accept:

 

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Refund Policy: There are no refunds for services rendered. If you have questions please contact us at Tina.Poppelreiter@lebonheur.org