MMAE >> Membership | Online Application: Step One

Eligibility:

If you haven't already, please take a moment to review who is eligible to join MMAE on our Membership page. If you are not eligible to join MMAE but would like to support our efforts to build a healthier community, please visit Support MMAE and consider making a tax-deductible contribution.

If you are interested in becoming a Friend of the Alliance, please email our membership chair.

Print Application:

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If you'd prefer to mail your membership application or pay by check, please click on the image below to download and print the Membership Application in the MMAE Brochure.

Please mail your application to:

MMAE
1112 Harding Place
Suite 200
Charlotte, NC 28204
704-376-3688

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Care to Join Us in Building a Healthier Community?

Now you can join the Mecklenburg Medical Association and Endowment online!

To become a new member of MMAE today, please proceed through our online Membership Application. All you need to do to join is provide us with your new member information and pay your initial membership dues via a major credit card or Paypal account.

(Note: This application is for individuals joining MMAE for the first time. If you are a current or past member looking to renew your membership and pay your annual dues, please visit our Online Membership Renewal page. If you simply need to update your contact information, click here to email membership your updates.)

Step 1: Enter New Member information

*First Name

*Last Name

*Spouse's Full Name

*Spouse's Specialty

*Address 1:

Address 2:

*City

*State

*Zip Code

Home Phone:

Work or Alt Phone:

Birthdate - Month

Birthdate - Day

*Email address
*Note: You will receive more information after joining about your communication preferences and how to access to the Members' Website.

I am interested in learning more about the following MMAE committees:
(To choose more than one, hold down Control on a PC or Command on a Mac and make your selections.)

Comments: (Optional)

*Required