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AM Delegate Interest Form
AM Delegate Interest Form
Local Component Medical Societies select the Annual Meeting delegates. Complete this interest form and the MMA will forward your information to your Local Component Medical Society.
First, Middle Initial, Last Name*
Clinic
City
Local Component Medical Society (if known)
Specialty
Email*
If you have any questions, please contact Tara Stone at
tstone@mnmed.org
.
Submit
* Required
1300 Godward St. NE, Suite 2500, Minneapolis, MN 55413 | Phone: (612) 378-1875 | Fax: (612) 378-3875 |
mma@mnmed.org
Copyright 2011 Minnesota Medical Association
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