Louisiana State Medical Society
Alliance
State
Alliance (LSMSA) and AMA Alliance Dues $60.00/Parish $______ Total
$______
Resident and Medical Student Spouses LSMSA and AMAA-No Charge/Parish
$______Total $_____
Parish
Alliances:
Avoyelles ~ Calcasieu ~ East Baton Rouge ~ Jefferson ~ Lafayette ~
Morehouse
Orleans ~ Ouachita ~ Rapides ~ Shreveport ~ St. Tammany ~ Tangipahoa ~
Terrebonne
Name___________________________________
Physician Spouse_____________________
Address________________________________ Phone ______________
Cell_______________
City___________________________________ Zip ______________
Parish Alliance _______________ Member-at-large___________ Email
___________________
Areas
of
Interest _______________________________________________________________
For information, contact Marci Freeman, Membership (225-313-3421) marci112@cox.net
To become a member, please call for address to send your check payable
to LSMSA to: Cindy Leopard, Treasurer (318-797-9189) cindyred@bellsouth.net