Membership Update

Membership Update

To update your AMA membership information, please fill out the form below. Make sure to fill out all blanks and to check your entries for typos. When finished, hit the submit button at the bottom of the page.

Allow 7-10 days for processing of membership information.

Membership Information

Name

Web Site URL

Gender

Male Female

Date of Birth

Home Phone

Mailing Address

City

State

Zip

Practice Name

Office Phone

Office Address

City

State

Zip

Professional Degree

M.D.

Other (Specify below)

Number of Years in Medical Practice

Primary Medical Specialty

Board Certified

Yes No

Licensure Number(s)

State(s)

Expiration Date(s)

Medical School Attended

Year Degree Conferred

Graduate School

Class of

GA State Association Member

Yes No

NMA Member

Yes No

Professional Activity
Other
Special Category (check if applicable)
Active Duty Military
Resident / Fellow
Medical Student
Physician Member of a Chartered Medical Society in a Non-US Country
Non-Physician Doctoral Level Medical School Faculty
International Involvement		(specify below)

Primary AMA Medical Selection

AMA Experts and Speakers' Bureau
The AMA Talent Bank includes medical experts who may be called upon to represent AMA to the media, as speakers, and on advisory panels. Do you consider yourself an expert in a particular sub-specialty or have an interest in participating on our speakers bureau?

2005 AMA Dues Schedule
- Membership in the Atlanta Medical Association is on a calendar years basis from January 1 through December 31. Membership renewal is October 1 through December 31, but new members are encouraged to join at anytime during the year. - Only credit card payments are accepted online. Should you wish to pay membership dues with a personal or business check, please contact the AMA office at 404-607-8362 for an invoice. denotes Associate membership. Associate members have no voting representation and may not hold office. *Pre-approval required

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