Home | About us | Members | Annual Convention | Forum | Contact us

Presidents messageGoverning bodyLearning resourceUseful LinksAKMG EmiratesHumanitarian ServicesMembershipEdit ProfileAKMG CME ProgramMSR & YPFPast Convention AKMG Vancouver Convention - 2010AKMG Alaska Cruise Convention - 2011AKMG Constitution and Bylaws

 
 
 

   AKMG Membership Application

First Name
Last Name
Address
City
State
Zip
Home Phone (xxx) xxx - xxxx
Office Phone (xxx) xxx - xxxx
Fax (xxx) xxx - xxxx
E-mail
Specialty
Medical College
Year Entered
Spouse Name
explain your link to Kerala - whether by "birth, education, parents, marriage"
Membership type
 
Please enter the string shown in the image in the form.
Please fill out a separate form, if spouse is a physician and applying for Joint Membership.
[ ] Annual Membership $50
[ ] Life Membership {Single} $ 500.00
[ ] Life Membership {Couple} $ 750.00
[ ] Joint Annual Membership (Couple) $75
[ ] Joint Life Membership(Couple) $750
[ ] Resident/Fellow Membership $10
[ ] Student Membership No Charge

[ ] Please make check payable to “AKMG” and mail it to:

AKMG Membership Dues
P. O. Box 74703

Clevland, OH 44194-4703

   

  You can download the membership form from this link:     Adobe Acrobat (PDF) format
  Word (DOC) format





All Rights reserved Powered by India websolutions