Pay Dues

MSA Dues

Title

First Name

Last Name

Department

Work Email

Personal Email

Is this your first time registering as an MSA Member?

Yes No

Would you be interested in joining the MSA working group?

Yes No

Address 1

Address 2

Postal Code

Province

Mobile Number

Phone Number

Local Extension

Membership Type

$200/year for Physicians

$50/year for Nurse Practitioners