2025-2026 Membership Application Form Auxiliary to the National Medical Association

2025-2026 Membership Form
Name

TitleFirst Name Last Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Registration Information
Phone Number
Format: (000) 000-0000.
Spouse

First Name Last Name
E-mail
Auxillary
Region
ANMA Life Member
I hereby apply for membership in the Auxiliary to the National Medical Association, Inc. and do hereby agree to abide by the laws governing this organization
MEMBERSHIP FEES

Our fiscal year begins on October 1st, and we will gladly accept your dues on or after October 1st. ANMA Life Members are exempt from paying dues but shall pay convention registration fees.
SCHOLARSHIP FUND DONATIONS

A "TAX DEDUCTIBLE DONATION" is always appreciated and needed. Please select donation option and add to payment.
Preferred Payment option
ANMA Life Member Donation (check)

Other
Membership Fees (Check)
Affiliation (Check)
Membership Fees - Check (Post February 1)
Affiliation (Check) Post February 1st
Convention Fees (Check)
Convention Fees - Check (Post May 30th)
Alma Givens Scholarship Fund (Check)
Omega Mason/Maude Bisson Scholarship Fund (Check)
Total Due (Check Payment)
prevnext( X )
Regular Members Dues 2
$175.00



Physician/Physician Spouse Dues 2
$75.00



ANMA Life Member
Optional

$100.00



Interim Member Dues 2
$175.00



Omega Mason/ Maude Bisson Donation
$25.00



Omega Mason/Maude Bisson Donation
$50.00



Omega Mason/Maude Bisson Donation
$75.00



Omega Mason/Maude Bisson Donation
$100.00



Alma Given Donation
$25.00



Alma Given Donation
$50.00



Alma Given Donation
$75.00



Alma Given Donation
$100.00



Subtotal

$0.00

Shipping

$0.00

Total

$0.00
Please mail forms with checks to:

ANMA

c/o Maria Bright - Financial Secretary

1703 South Thames Court

Greenville, NC 27858

Phone: (919) 641-6195
If assistance is needed to complete, contact the National office at nationaloffice@anmanet.org or 301-495-3779.

Should be Empty:

2025-2026 Membership Form

MEMBERSHIP FEES

SCHOLARSHIP FUND DONATIONS

Payment Methods