2025 Membership Application

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Membership is based on Calendar year from Jan through Dec.

Email *

Are you currently receiving emails from the Association? *

Yes

First Name: *

Middle Name:

Last Name: *

Professional Designation: *

DMD

DDS

PharmD

PA-C

ARNP

HEALTHCARE PROFESSIONAL STUDENT

Other:

State License Number (students type N/A) *

Specialty: *

Mailing Address: *

Phone number: *

Membership Dues *

$85 One Year Membership

$210 Three Year Membership

FREE - Healthcare Professional Student

Method of Payment *

Paid Wave Invoice

Zelle (zelle to vampgroupfl@gmail.com). Add vampgroupfl@gmail.com to your contacts first.

Check payable to “ Vietnamese American Medical Professionals" and mail to : Son Ho, MD 1517 Cloverlawn Ave, Orlando FL 32806

N/A - Healthcare Professional Student

FOR HEALTHCARE PROFESSIONAL STUDENTS, please provide:

Current Professional School

Student Email

Expected Graduation Date

Comments

A copy of your responses will be emailed to the address you provided.

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