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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First Name
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Last Name
*
Address
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Address Line 2
 
City
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State
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ZIP Code
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Phone
 
000-000-0000

Email will be the primary vehicle for Section communications.
Privacy Policy


 
 

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.
Birth Year:
 
How did you hear about the MAS? 
 
 

 
 

Minority Affairs Section Membership Registration

Membership

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Are you an AMA member?
 
Yes
No
Medical Education Number
 
Special Interests
 
Other Comments