SHSMD Membership Application

Gift of Membership

Thank you for giving the gift of membership to someone!

Please fill out the information below, and SHSMD will take care of the rest.

First and Last Name

Title

Organization

Email Address

First and Last Name

Title

Organization

Street Address

City

State

Zip code

Telephone

Email Address

Member from a health care provider organization

Consultant member

Vendor member

Faculty member

Student member

25% off membership renewal

15% off conference registration

10% off one 2026 credential course