 |
|
Kevin G. Berry, M. D., Secretary-Treasurer |
|
|
Annual Dues: Active Member $100.00
(All members: Active Duty & Retired)
|
|
|
|
|
|
SMCAF Education
Fund ________________________________ $ญญญญ_____________
|
Please
make check payable to SMCAF
TOTAL $ ____________ |
|
|
|
|
|
|
|
|
|
Address Correction:
____________________________________________________ |
____________________________________________________________________ |
|
E-mail Address: ________________________________________________
Specialty: ____________________________________________________ |
|
|
Current AMSUS Member: Yes __________ No__________
SMCAF members must be AMSUS members.
If you are not an AMSUS member, do you intend to join?
Yes __________
No __________ I wish to resign my membership in SMCAF.
|
AMA Member |
Yes _____ |
No _____ |
AMA Member number ____________ |
|
|
|
|
|
|
|
|
|
|
The Society of Medical Consultants to the Armed Forces |
5 Southern Way |
Fredericksburg, VA 22406 |