Join NYMGMA - Medical Group Management Association

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NYMGMA - An organization supporting practice management professionals within New York State

NYMGMA Membership Registration Form

Complete the form below to register for New York MGMA:

Applicant Name:

Title:

Group Name:

Address:

Address 2:

City/State/Zip

Phone Number:

Fax Number:

Email Address:

Confirm Email:

Type of Practice:

Solo Partnership PC
Hospital Based Faculty Practice Other

Number of Physicians:

We have several standing committee that could use your help. Would you be willing to serve on any of the following? (check all that apply)

Program Committee Membership Committee
Newsletter Committee Legislative Committee
Sponsor/Vendor Relations

We are interested in providing seminars and continuing education programs that our membership will find helpful and of interest. Are there any topics you would like to see offered?

Do you have any other comments or suggestions to assist us in being more responsive to our membership?

Regional Affiliates: Your practice location typically determines which regional affiliate your membership extends to. An affiliate representative will be contacting you about local meetings.

Adirondack	Northeast/Albany	Buffalo	Central NY
New York City	Long Island	Rochester	Southern Tier

The New York State MGMA annual membership dues are $90. Please indicate how you will be submitting payment.

By Check - Please mail $90 check made payable to NYMGMA to:

New York MGMA
30 Jericho Turnpike, #170
Commack, NY11725

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