MVMA Communications Request
The MVMA member completing the form:
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First Name
Last Name
Email address:
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example@example.com
Name of the clinic:
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Name of the office manager/clinic staff:
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First Name
Last Name
Email address of the office manager/clinic staff:
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example@example.com
I understand that the MVMA is trying to help facilitate communication between the MVMA and its members. I would like for my practice manager/clinic staff to have access to the MVMA member side of the website, MVMA members-only Facebook and be eligible to obtain copies of the Post and other MVMA materials. I will ensure that my practice manager/clinic staff understands that some information in various MVMA publications and on the MVMA website is sensitive and confidential, and may not be shared with others.
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Yes
Date
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-
Month
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Day
Year
Date
Signature
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Submit
Should be Empty: