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    AOMSM Membership App Form

    Uploaded by

    Rebecca Schirber
    The document is a membership renewal form for the AOMSM organization. It lists the different membership levels including full professional member ($150), first year practitioner ($75), student member ($35), corporate sponsor, and friend of AOMSM ($35). It requests the member's name, address, email, phone and license number to be included in their database.

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    AOMSM Membership App Form

    Uploaded by

    Rebecca Schirber
    23 views1 page
    The document is a membership renewal form for the AOMSM organization. It lists the different membership levels including full professional member ($150), first year practitioner ($75), student member ($35), corporate sponsor, and friend of AOMSM ($35). It requests the member's name, address, email, phone and license number to be included in their database.

    Original Description:

    AOMSM Membership Form 10.2013

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    The document is a membership renewal form for the AOMSM organization. It lists the different membership levels including full professional member ($150), first year practitioner ($75), student member ($35), corporate sponsor, and friend of AOMSM ($35). It requests the member's name, address, email, phone and license number to be included in their database.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as doc, pdf, or txt
    23 views1 page

    AOMSM Membership App Form

    Uploaded by

    Rebecca Schirber
    The document is a membership renewal form for the AOMSM organization. It lists the different membership levels including full professional member ($150), first year practitioner ($75), student member ($35), corporate sponsor, and friend of AOMSM ($35). It requests the member's name, address, email, phone and license number to be included in their database.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as doc, pdf, or txt
    of 1

    Please complete and mail to:

    AOMSM, PO Box 775, Beverly, MA 01915


    Checks made payable to: AOMSM
    AOMSM@aol.com

    617.340.9566

    Membership/Annual Renewal
    Full Professional Member ($150) Save = 2 years ($250)
    Licensed Acupuncturists Only > Must provide MA License #

    First Year Practitioner ($75)


    Licensed Acupuncturists Only

    Student Member ($35)


    Corporate Sponsor (Inquire for rates at admin@aomsm.org)
    Friend of AOMSM ($35)
    Donor (Any Amount Welcome)

    Please include your name, address, email address and phone number as you would
    like them to appear in our database. Please print legibly
    Personal Information
    Name: _______________________________________________ MA License # : _____________________
    Address: _______________________________________________________________________________
    Phone: _____________________________________ Fax : _______________________________________
    Email: _____________________________________Website:_____________________________________

    Business Information
    Name: _______________________________________________MA License #: _______________________
    Address: _________________________________________________________________________________
    Phone: _____________________________________ Fax : _________________________________________
    Email: _____________________________________Website:______________________________________

    Visit us at www.AOMSM.org

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