Home - Scmsa Alliance Membership

Form for Membership and/or
Holiday Sharing Card
scroll down for payment

First name including salutation (Dr., Mr., Mrs., Ms., etc.)

Last name

For 2022 Holiday Sharing Card, please indicate name(s). For example, "Jane and John Doe"

Phone

For 2023 Membership, please include your specialty (if physician), spouse/significant other's name and specialty. Also, interested in: Bunco? Book Club? Playdates? Other?

Street Address, City, State, ZIP

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PAYMENTS

Holiday Sharing Card

PayPal link to contribute to the Holiday Sharing Card. $100 minimum donation requested.

Sharing Card - $100

County Dues

Square link to pay county dues online.

County Dues - $75

State Dues

Optional. Square link to pay state dues online.