MMDA Membership Form

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Membership Benefits:

Access to members-only sections of our website providing the following:
- CMS' memo on delegation of visits to NPs and PAs in the subacute and LTC units of a facility
- Quick access to OHCQ's Transmittals and Clinical Alerts
- Easy, quick access to MOLST information and forms
- Accesss to minutes of business meetings
- State legislative information
- Quick download of memos from CMS on specific topics, such as the memo in 2014 on CPR in nursing homes
- Easy access and link to CMS Nursing Home Compare and Physician Compare
- Best practices: Dementia care, DHMH infection prevention information
- Link to CMS' website for Open Payments
Advocacy:
- Leadership, education, and advocacy on federal and state-level issues affecting our patients, residents, colleagues and community
Annual Scientific Meeting:
- CEUs for physicians, APNs, and medical directors
- Discounted registration fee for members

You can register to become a member or renew your MMDA membership online. Our membership year begins every January 1 and ends on December 31 of the same calendar year. Payment of dues applies to the calendar year when the payment is received, except during the 3 month period prior to January 1. Dues paid during the 3 months prior to the following date of January 1 will be applied to the coming calendar year. For example, paying dues on October 1, will provide membership for 1/1/xx - 12/31/xx. However, payment of dues on September 30, or before will provide membership for the prior year

Please complete the fields in the membership application below and then click on the submit button. After you successfully submit your application, please return to this page to make your online payment for your membership using the secure PayPal system. If you have any questions about membership, please contact MMDA at mmdawebsite@gmail.com.

Membership Application

Please submit payment using PayPals secure system then complete this membership application. You will receive an e-mail confirmation that your application has been received. Please allow 3-5 business days for MMDA to contact you with additional membership information.

First Name *

Last Name *

Degree *

Address *

Address 2

City *

State *

Zip *

Country *

Phone *

Number where you can be reached regarding MMDA membership.

Fax

Fax where you can be reached regarding MMDA membership.

Email Address *

E-mail where you can be reached regarding membership (this address will not be shared without your permission.

LTC Facilities *

Please list the LTC facilities at which you work. Please include: street address, city, state and zip code. Put each facility on a separate line.

I am interested in working on the following committee(s)

Membership Type *

General (Physicians, APNs, PAs in practice) - 1-year membership - $125

Affiliate (Nurses, DONs, DDS, CNS, DPM, students of all disciplines, residents, fellows and other IDT members) - 1-year membership - $75

MMDA Membership (1-year membership)

Send Payment After you submit this membership dues form, you will be taken to a payment page where you can choose to pay your membership dues with a credit card using PayPal's secure onine system, or you may elect to send in your payment via fax or U.S. mail. Please be sure to click the submit button below.

Payment Method *

Credit card online via PayPal (submit payment on next screen)

Check (mail check to MMDA Membership, C/O Lisa Williams, 1211 Cathedral Street, 3rd Floor, Baltimore, Maryland 21201-5516)

Fax credit card information to (410) 385-0154

Please select which payment method you will use for your membership dues. If you will be paying online you will need to complete the payment information on the next screen before being directed to Paypal for debit/credit card validation. Your membership fee will show as Paypal on your bank or card statement.

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