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West Virginia State Medical Association
4307 MacCorkle Ave, S.E.
P.O. Box 4106
Charleston, WV 25364
ph. 304-925-0342 fx.304-925-0345
 
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Medical Student Section Application

To request membership in the West Virginia State Medical Association's Medical Student Section (WVSMA-MSS), please complete this form and submit.  You will be invoiced for the following dues:

Four-Year Membership

$68

Three-Year Membership

$54

Two-Year Membership

$38

One-Year Membership

$20

Remember the WVSMA subsidizes an American Medical Association (AMA-MSS) membership for you.  By joining WVSMA-MSS you will automatically become an AMA-MSS member.  If you have any questions, call Mona Thevenin at (304) 925-0342 ext. 16 or email at mona@wvsma.com

 
* Name: (full name-no initials)
* Preferred Mailing Address:
* City:
* State:
* Zip:
* Phone number:
Fax number:
* Date of Birth:
* Place of Birth:
* E-Mail Address:
* Medical School:
* County/State of Residence Upon Entrance to Medical School:
* Year of Medical School (1st, 2nd, 3rd, ect.):
* Anticipated Year of Graduation:
Spouse's Name:
   
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