MSA Membership Form

Personal Information

Are you currently medical staff at Langley Memorial Hospital?(Required)

Yes

Name

First Last

Address(Required)

Street Address Address Line 2 City Province Postal Code

MSP Number(Required)

Preferred Email Address(Required)

Mobile Number

Position

Status

Department

Membership Type

Membership Due - $155 (A $5 convenience fees is included in the dues)

Price:

Total

Membership Agreement(Required)

I agree to become a member of the LMHMedical Staff Association and abide by its bylaws and MSA staff rules

I consent to be contacted occasionally via email to be informed about events, opportunities and services provided by the LMH Medical Staff Association and the LMH Physician Association

I consent to using my photographs/videos taken at MSA/LMHPA sponsored on the website