NJMS Alumni Association Annual
Membership Online Secure Payment Form

Please note that paying for your NJMS Alumni Association membership via online credit card will be unavailable between the hours of 11:00 PM to 11:59 PM (Eastern Time) on all Saturday, Sunday, and Wednesday nights, due to weekly scheduled system maintenance. We apologize for any inconvenience.

SUPPORT AND STRENGTHEN THE ALUMNI ASSOCIATION BY BECOMING AN ACTIVE MEMBER. WE DEPEND ON YOUR MEMBERSHIP TO FUND THE OFFICE AND TO SPONSOR THE NUMEROUS PROGRAMS FOR THE MEDICAL STUDENTS AND SCHOOL.

If you would like to pay your membership on-line, please complete and submit the following form using our Secure Server. We accept MasterCard, Visa or American Express.
MEMBERSHIP VALID: JULY 1 - JUNE 30

Note: The fields below marked with the red star * must be completed to process this form.

Personal Information


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*First Name:  
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*Class of:  

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Home Address

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Fax:  






Office Address

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*Is this information new?   Yes    No

*Membership Categories
General Membership ($75.00)
Lifetime Membership ($1,000.00)
Residents in Training ($15.00) - Membership for 1st year graduates is a gift from the Alumni Association
Annual Fund Donation  
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