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

Please look at our website for further information on the following committees and interest groups, and indicate your interest in participation below (you may select more than one for either category):

Interest Groups:

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Committees:

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Membership Dues

AFF Membership

Quantity:
$40.00

2022 Recruit Discount - AFF Membership

Quantity:
$30.00

Who did you recruit?

Student/Resident Staff Membership

Quantity:
$20.00

AFF Lifetime Membership

Quantity:
$300.00