Download Form (PDF) Name of business or firm: * Primary contact person: * Title: Email: Mailing Address: * City: * State: * Zip: Telephone #: * Fax #: Website Address: Summary Please provide a brief summary (100 words or less) of the services your organization provides. This summary will be used in MMA’s Corporate Affiliate Information Sheet. The Information Sheet will be included in the materials for MMA's meetings, seminars and in various mailings to our member physicians throughout the year. You are also welcome to enclose brochures or other promotional materials you believe would be helpful for us to keep on file here at MMA. Applicant: * Applicant Title: Yearly Corporate Membership dues: October 1 - September 30: $1,000.00 You will be invoiced for dues once your application is received and accepted.