To join The Pittsburgh Guild of the Catholic Medical Association, please:
1.) Print this page
2.) Complete this form
3.) Return completed form with Check payable for
the appropriate dues amount
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The Pittsburgh Guild of the CMA
2011-2012 Membership Form
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NAME_____________________________________________________________
ADDRESS__________________________________________________________
PHONE____________________________________________________________
E-MAIL____________________________________________________________
SPECIALTY_________________________________________________________
___ Physician Member (dues $50)
___ Non-Physician Associate (dues $25)
___ Medical Student, Intern, Resident or Fellow (No dues!)
___ Seminarian (No dues!)
Please make checks payable to:
"The Pittsburgh Guild of the Catholic Medical Association"
Please return completed form to:
The Pittsburgh Guild of the CMA
2012 Stillwater Drive
Gibsonia, PA 15044
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