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Membership Renewal Payment

Membership Renewal Payment

Membership Payment Form

First Name *

Last Name *

Email *

Email address where you would like payment confirmation sent.

Invoice Number *

District Change

If your selected District Medical Society is different from that shown on the Membership Renewal Notice – please select your new District.

Membership Categories *

Full — $1,937.25

Out-of-Province — $52.50

Retired — $99.75

I have read and agree to the Membership Agreement Terms and Conditions *

Total

Includes 5% GST (GST #107660466 RT0001)

Billing Address

Please enter information exactly as it appears on your credit card. (only MasterCard and Visa accepted).

Address Line 1 *

Address Line 2

City *

Province *

Postal Code *

Credit Card *

Canadian Medical Association (Optional)

By checking this box, I agree that my name and email will be shared with the Canadian Medical Association ("CMA") and used by them in accordance with the CMA privacy policy here. I understand that CMA and/or its affiliated companies may contact me via email. I understand that Doctors Manitoba is not responsible for the use by the CMA of my name and email address. I understand that by checking this box, I am not signing up for CMA membership.

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Membership Renewal Payment

Membership Payment Form

Billing Address