Mimda Annual Conference 2022 - Michigan Medical Directors Association

First Name *

Last Name *

Preferred Name for in-person badge

Degree/Credentials *

(e.g. MD, DO, CMD, GNP, PharmD, etc.)

Email Address *

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

Profession *

Primary Place of Employment *

Address *

City *

State *

Zipcode *

Phone *

Number where you can be reached regarding registration

All cancellations must be made in writing to MIMDA. Notices can be emailed to michiganmda@gmail.com. Cancellations received by October 4, 2022, will receive a full refund less a $50.00 administrative fee. Cancellations received between October 5-11, 2022, will be refunded half of the registration fee. Fees will be refunded the same way they were paid to MIMDA. Please allow up to four weeks for delivery of refund if payment was made by check. Cancellations received after October 11, 2022, will result in the forfeiture of all registration fees. No-Shows will also forfeit all registration fees. Partial or full fees that have been forfeited cannot be applied to subsequent meetings.

Payment Method *

Credit card online via Paypal (you do not need a Paypal account to use this method) You will be directed to a shopping cart page after submit
Check (mail check to Michigan Medical Directors Association, 2843 E. Grand River Ave, #252, East Lansing, MI 48823. ) payable to Michigan Medical Directors Association.

Please select which payment method you will use for your membership dues.

Registration Fees *

Physician / Member, Fri. & Sat. = $250
Physician / Non-member, Fri. & Sat. = $300
NHA’s, NP, RN, LPN, PA, DoN, PHYSICIAN IN TRAINING, Other, Fri. & Sat. / Member = $200
NHA’s, NP, RN, LPN, PA, DoN, PHYSICIAN IN TRAINING, Other, Fri. & Sat. / non-member = $250
Student, Fri. & Sat. = $50

Dinner Choice *

Chicken
Beef
Vegetarian

If you are bringing a guest there will be an additional $35 charge. Please contact michiganmda@gmail.com with guest name and dinner selection.