Membership Payment Page

First Name

Last Name

E-mail

Retype Email

Preferred Phone Number

Billing Address

City

State

Zip Code

Country

Major

Predicted Graduation Date

Days available for Activities

Times Available for Activities

Early Bird (until Sept 15) Premed AMSA 1-Year Membership: $10.99 ($10.00 + $.99 convenience fee)

When you click submit, you will be redirected to the Google Checkout page where the order will be finalized. Disregard shipment status information as nothing will be shipped. The information you provided on this page will be entered into our membership records. Once we receive your payment, you will be a Premed AMSA member. To get your t-shirt, email uofu.premedamsa@gmail.com and it will be available at the next event (t-shirt supply is limited) Thank you.