Defence Medical Association of Canada - Application for Membership

Membership Application Form

Please type your email address:

1. Personal Information

Rank or Title: First Name: Last Name:
Street Address:
City: Prov/State: Post/Zip Code:
Telephone: Fax:
(Please format telephone number as above, and delete format example text before entering information)

2. Affiliation/Service

Decorations and Post Nominals:
Military Service (if applicable):
Professional Qualifications:
Current Position:
Position(s) pre retirement:
Any areas of Special Interest:

3. Other

Closest DMA Branch:
Date of Application:

1. Fill out the form above on-line, click on "Apply" and mail your cheque or money order to:

- OR -

2. Print out this form, fill it out and mail a paper copy with your cheque or money order to:

MEMBERSHIP
Defence Medical Association of Canada
Post Office Box 538
Orleans ON
K1C 1S9

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