Group Membership Application

Active Members Receive a Discount with Group Membership

The SASM has decided to offer group membership to those organizations who wish to remit payment for multiple physicians’ member dues at once.

You will receive a $25 discount per member if you register 3-5 members (at $75/member) or a $50 discount per member if you register 6+ members (at $50/member).

To take advantage of this offer:, scroll down and complete your group membership application below.

Please note: Group membership is only available to members who fall into the “Active Membership” category.

Group Membership Application

Use the following Group Membership Application form if you are registering three (3) or more Active Members (Physician and Scientist members with the ability to vote, hold office, and serve as Directors of Board).

Please note: If your group membership consists of more than 10 members, please contact the SASM office.

Group Contact First and Last Name*
Group Member 1: First AND Last Name*
Group Member 1: Degree(s)*
Group Member 1: Email Address*
Group Member 2: First AND Last Name*
Group Member 2: Degree(s)*
Group Member 2: Email Address*
Group Member 3: First AND Last Name*
Group Member 3: Degree(s)*
Group Member 3: Email Address*
Group Member 4: First AND Last Name
Group Member 4: Degree(s)
Group Member 4: Email Address
Group Member 5: First AND Last Name
Group Member 5: Degree(s)
Group Member 5: Email Address
Group Member 6: First AND Last Name
Group Member 6: Degree(s)
Group Member 6: Email Address
Group Member 7: First AND Last Name
Group Member 7: Degree(s)
Group Member 7: Email Address
Group Member 8: First AND Last Name
Group Member 8: Degree(s)
Group Member 8: Email Address
Group Member 9: First AND Last Name
Group Member 9: Degree(s)
Group Member 9: Email Address
Group Member 10: First AND Last Name
Group Member 10: Degree(s)
Group Member 10: Email Address
Organization*
Address 1*
Address 2
City*
State/Province
Zip Code*
Country*
Phone*
Fax*
Web site*
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If you are experiencing issues with your registration, please contact the SASM Office at 414-389-8608 or info@sasmhq.org.