Membership Application Name * First Name Last Name Email * Phone * (###) ### #### Are you a resident of Virginia? * Yes No Which membership are you applying for? * Physician Resident or Fellow Medical Student Signature: Members are expected to pay annual dues and attend at least one meeting in the Fall and Spring. Meetings are held on the second Thursday of select months and catering is provided. * Thank you for applying to the Albemarle County Medical Society. We review applications monthly and will notify you of our decision thereafter. Pay my annual dues: Pay Dues
