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Minority Affairs Section Membership Registration

If you need additional information about the AMA-MAS, please call the AMA-MAS office at (312) 464-5678.

Membership is free and open to all AMA members.

Contact Information

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Last Name
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Address
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City
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Phone
 
000-000-0000

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Minority Affairs Section Membership Registration

Demographics

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Category
 
MD
DO
Medical Student
Medical Specialty
 
Gender
 
Female
Male

(Optional) Race/Ethnic Background:

 
 
Black/African-American
 
 
Hispanic/Latino
 
 
Asian
 
 
White
 
 
American Indian/Alaska Native
 
 
Native Hawaiian/Other Pacific Islander
 
 
Other
Please specify, if other.
 
 
 
I do not wish to designate a race/ethnicity.
How did you hear about the MAS? 
 
 

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Minority Affairs Section Membership Registration

Membership

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Medical Education Number
 
Special Interests
 
Other Comments
 

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