AFF Membership - New/Renewal

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General Information

AFF Membership Information

First Name: Required

Last Name: Required

Address 1: Required

City:

State:

Zip:

Phone Number: Required

Email:

My Affiliation to the Medical Center

My spouse is a faculty member/professional staff, please list spouse's name and department:

I am a faculty member/professional staff, please list your department:

My spouse is a student/resident staff, please list spouse's name and department:

I am a student/resident staff, please list your department:

I am a Community friend who supports HMC/COM:

Committees, Interest Groups and Hospital & Community Outreach Programs

Please look at our website for further information on the Committees, Interest groups, and Hospital & Community Outreach Programs, and indicate your interest in participation below (you may select more than one for either category):

Committees:

Use Ctrl or Shift keys to multi-select.

Interest Groups:

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Hospital and Community Outreach Programs

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Membership Dues

AFF Membership

Quantity:
$50.00

Student/Resident Staff Membership

Quantity:
$20.00

AFF Lifetime Membership

Quantity:
$300.00