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Fax opt out form

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US physicians and students attending US-accredited medical schools can use this form to opt out of receiving AMA fax communications. Please be sure to scroll to the bottom of the page to submit your information.

For validation purposes, please provide the following information:

*Asterisk indicates required field

*Are you a:
Physician    Resident    Student

*First Name

Middle Initial

*Last Name

*Date of birth (MM/DD/YYYY)

*Year of graduation or expected year of graduation from medical school (YYYY):

*E-mail address

Your e-mail address will not be shared, sold, traded, exchanged or rented. See our Privacy Policy for more information.

Fax opt out
 By making this selection and providing your fax number below, you are requesting to not receive AMA fax communications.

*Fax number

Last updated:Jul 31, 2006
Content provided by: Data Resources