Membership Application

Membership can become the initial step of a rewarding overall experience. We encourage you to join our association of black doctors to help foster growth and development in your chosen profession.

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Name*
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Mailing Address*
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Education

Board Certification

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Please enter your initials to indicate your signature.

Dues payments must be submitted at the time of application submission.
– Practicing physician $250/calendar year
– First year of practice $100/calendar year
– Resident/Fellow $50/calendar year
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