Student Membership without Mentorship, Minority Women In Sports Medicine

Student Membership

without Mentorship

Name

Email Address

Phone

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Current Area of Study ( i.e Athletic Trainer, Physical Therapist, Physician, etc.)

Current Institution

Anticipated Graduation Year

Additional Information ( i.e specialities, areas of expertise, clinical interest)

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Yearly Membership Payment ($35) *

Student Membership w/ no Mentor Interest