Online & Annual Registration Form

If you prefer to register online initially or annually, please complete the form below in full and we will contact you either by phone, email or by U.S. mail.  Please be sure to complete all required fields including your email address and your contact address using the full street address, the city, the state and the complete zip code!  When you Save and Submit this form you will automatically go to PayPal where you can then pay your dues on their secure web page!

Your Full Name (required)

Type of Professional (required)

Complete Address (Street, City, State) (required)

Zip Code (required)

Location of Address (Select One) (required)

Phone Number (required)

Phone Location (Select One) (required)

Preferred Email Address (required)

Fax Number (if you have a Fax)

Pager Number (if you have a Pager)

Your Specialty (required)

Parish Registration (required)

Hospital or Professional Affiliation (required)

Do Wish to Register for the Baltimore Guild? (Select One) (required)

How Should We Contact You (Select One) (required)

"The BG-CMA is a 501(c)(3) tax-exempt organization. Contributions are deductible to the extent permitted by law."
"Donations help to defray costs of Guild activities as well as support medical student activities, and student participation"