SCMA - Join SCMA

If you are a physician, to join the SCMA, please complete the form below with your information and select "next" to submit payment. Residents and Students should click the applicable buttons below.
resident members student members

Physician Information

First Name:

Middle Initial:

Last Name:

MD/DO

Suffix

Email address:

Phone:

Address Line 1:

Address Line 2:

City:

State:

Zip:

Professional Background Information

Birthdate / /

SC License Number:

Medical School Attended

Graduation Year:

Residency Training Location:

Residency Year Completed:

Primary Specialty:

County Medical Society:

Practice Information

Practice Name

Practice Address:

City:

State:

Zip:

Practice Phone:

Practice Fax:

Practice Manager Name:

Practice Manager Email:

In which type of organization do you practice?

How many physicians practice in your organization?

How many hours a week do you practice?

Billing Information

Please note that billing address must match the address associated with your credit card for payment to go through.

Same as contact information

First Name:

Last Name:

Email address:

Phone:

Address Line 1:

Address Line 2:

City:

State:

Zip:

Payment Information

Membership Level:

Offer Code:

Amount Due: $

Card Type:

Card Number:

Expiration Date: /

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