22-23 First Saturdays Registration Form

2022-2023 First Saturdays Registration Form

Helping Medical Professionals Connect with Christ
First Saturdays is a program that covers a broad range of medical and spiritual topics related to all of the contemporary issues facing Catholic doctors today. This will be an interactive format with Catholic catechesis and discussion. The goal is to light the fire of the Holy Spirit in area Catholic medical providers and to integrate Christ and His Church fully into their practice.

The annual cost for this 9-month cycle is $300 for doctors and $50 for all others. Premed, Med students and Residents are welcome free of charge! Spouses and children are encouraged to attend and are included as part of the registration fee.

We will be updating the physician directory on www.catholicmedkc.org, please provide directory information.
WEBSITE LISTING INFORMATION

This information will be placed on the CMA KC website public physician directory
Name *

First Name Last Name Credentials
Company/Institution *
Type a question
Medical Specialty

Allergy & Immunology Anesthesiology Colon & Rectal Surgery Dermatology Emergency Medicine Family Medicine Internal Medicine Medical Genetics and Genomics Neurological Surgery Nuclear Medicine Obstetrics & Gynecology Ophthalmology Orthopaedic Surgery Otolaryngology – Head and Neck Surgery Pathology Pediatrics Physical Medicine & Rehabilitation Plastic Surgery Preventive Medicine Psychiatry & Neurology Radiology Surgery Thoracic Surgery Urology
Specialty *
Office Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Office Number *

Area Code Phone Number
Link to website:
Provide a hyperlink(s) to your website, Linked In profile, or link of choice.
SOCIETY MEMBER INFORMATION

This information is for society purposes only and will not be shared publicly.
Home or Preferred Mailing Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email *
example@example.com
Mobile Number *

Area Code Phone Number
Are you a National CMA member? *

Yes No
The annual program cost for this 9-session cycle beginning in September is $300 for Doctors, $50 for other healthcare professionals and FREE for Premed, Medical students and Residents.
If you are joining after the program start date and you would like to pro-rate your program cost based on the number of sessions left please note the amount of months you plan to join the activity. An invoice will be mailed to you within 7-10 business days after submitting this form.
Not applicable to FREE memberships.
Which Membership are you selecting?

Doctor Membership ($300) General Membership ($50) Premed, Med students and Residents (FREE)
PayPal is the payment tool used to process credit/debit card payment - you do not need a PayPal account to use this tool. After hitting submit, you will be taken to the PayPal login page, simply scroll down to the light blue box labeled "Pay with Debit or Credit Card" and you will be taken to a PayPal Guest Checkout page.
Credit/Debit Card Payment *
prev next ( X )
First Saturdays - Doctor's Membership $ 300.00

First Saturdays - General Membership $ 50.00

Total $ 0.00
loading smart payment buttons...

The payment is ready! It will be completed once you submit the form.
Should be Empty:

Now create your own Jotform - It's free! Create your own Jotform

2022-2023 First Saturdays Registration Form

WEBSITE LISTING INFORMATION

SOCIETY MEMBER INFORMATION