NAAMA 2024 Membership Form Valid Jan 1-Dec 31/2024.Membership(Required) New Member Old Member Student: Premed, Medical, Residency Please choose oneSTOP! Premed students, Medical students and Residency are with NAAMA Nextgen. Please follow the following link for memebership naamanextgen.comAbout YouSalution(Required)Dr.Mr.Mrs.Ms.Click to choose from a listYour Name(Required) First Last Specialty(Required) Your Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code How Can We Reach You?We would love to chat with you. How can we get in touch?Your Email Address(Required) Cell Phone(Required)MembershipI am a member of Georgia Chapter Ohio Chapter Michigan Chapter Houston, Texas Chapter Illinois Chapter New Jersey Chapter LA, California Chapter San Diego, California Chapter St. Louis, Missouri Chapter No Chapter in My Area Please choose oneMembership with Chapter Fee(Required) ACTIVE (MEDICAL DOCTOR / DENTISTRY / PHARMACY / SCIENTIST) - With Chapter Fee $300 ACTIVE (NURSING / ALLIED HEALTH PHYSICIAN ASSISTANT, PUBLIC AND MENTAL HEALTH PROFESSIONAL) - With Chapter Fee $250 AUXILIARY - SPOUSE / FRIEND OF NAAMA - With Chapter Fee $150 RETIRED - With Chapter Fee $150 Lifteime Memebership $6000 Memebership levels for memebers with chapter in their area. Please Choose your membership level. Membership without Chapter Fee(Required) ACTIVE (MEDICAL DOCTOR / DENTISTRY / PHARMACY / SCIENTIST) - No Chapter in My Area $225 ACTIVE (NURSING / ALLIED HEALTH PHYSICIAN ASSISTANT, PUBLIC AND MENTAL HEALTH PROFESSIONAL) - No Chapter in My Area $175 AUXILIARY - SPOUSE / FRIEND OF NAAMA No Chapter in My Area $75 RETIRED - No Chapter in My Area $75 Lifetime Memebership Memebership levels for memebers without a chapter in their area. Please choose your memebership level!Total Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20242025202620272028202920302031203220332034203520362037203820392040204120422043 Security Code Cardholder Name
