PMDA Membership Application

ONLINE MEMBERSHIP APPLICATION
Name:*

First NameLast NameCredentials
Title:
Ex. PhD., M.D., M.S.W.
Preferred Mailing Address:*

HomeBusiness
Personal Email*
example@example.com
Phone Number:*
Please enter a valid phone number.
Home Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Work Email:
example@example.com
Business Phone Number:
Please enter a valid phone number.
Work Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Medical License Number:
How did you learn about PMDA?*

Internet SearchEmailSocial MediaWork/Co-workersReferred
Who referred you?

Types of Membership:
Individual Membership

Any physician, pharmacist, nurse, physician assistant or doctorly-prepared clinician licensed in Pennsylvania whose professional medical services are provided in whole or in part within the Post-Acute and Long-Term Care settings. They may attend meetings, enter into discussions, express opinions, serve on committee, and be entitled to vote in matters concerning the business of the Association and to hold office.
Affiliate Membership

Physicians in training, students, other health care providers. They may attend meetings, enter into discussions, express opinions, serve on committee, but are not entitled to vote in matters concerning the business of the Association or to hold office.

Please select your membership type*

1 Year Physician MembershipIndividual Membership

$130.00

2 Year Physician MembershipIndividual Membership

$250.00

1 Year NP/PA, Pharmacist, Doctorally-Prepared Clinician MembershipIndividual Membership

$95.00

2 Year NP/PA, Pharmacist, Doctorally-Prepared Clinician MembershipIndividual Membership

$180.00

1 Year Allied Health (RN, Administrators & Social Workers) MembershipAffiliate Membership

$75.00

2 Year Allied Health (RN, Administrators & Social Workers) MembershipAffiliate Membership

$140.00

1 Year Emeritus, Student & Fellows Membership

$ Free

Total

$0.00

Volunteer

Part of the value of membership is the opportunity to help keep PMDA a vital resource for members of the PALTC community. Please check one of the boxes below if you are interested in serving on a PMDA committee.
How would you like to volunteer? (Optional)

Educational ProgramMembershipNewsletterPublic Policy
Member Benefits
Continuing Education

PMDA offers opportunities to advance your medical knowledge and skills through our newsletter, member e-mails, website, regional meeting and annual continuing medical education symposium. Members attend the Annual Symposium for a reduced member registration fee.
Public Policy/Advocacy

Membership in PMDA provides the opportunity to strengthen your voice in Harrisburg on matters pertinent to the field of long-term care. PMDA is taking the initiative to represent, educate, and advocate on behalf of physicians who practice in long-term care. PMDA also works collaboratively with AMDA on issues of national importance to long-term care.

PMDA Trainee Education Fund

The PMDA Trainee Education Fund supports PMDA’s efforts to educate, recognize and inspire post-acute and long-term care clinicians in training in the benefits and rewards of a career in the PALTC continuum. Your contribution will allow us to continue to offer complimentary registration to the Annual Symposium for fellows, residents and students. Help us invest in the future of practice in PALTC medicine.
Would you like to contribute to the PDMA Trainee Education Fund?

YesNo
Click Here to Contribute to the PMDA Trainee Education Fund
Should be Empty:

ONLINE MEMBERSHIP APPLICATION