Please complete (check all that apply) and mail to:

AOMSM, PO Box 775, Beverly, MA 01915

Checks made payable to: AOMSM
AOMSM@aol.com

781.893.2185

Membership/Annual Renewal
Full Professional Member ($150) Save = 2 years ($250)
Licensed Acupuncturists Only > Must provide MA License #

First Year Practitioner ($75)

Licensed Acupuncturists Only

Student Member Free while in School

Expected Graduation Date ____________
Corporate Sponsor (Inquire for rates at admin@aomsm.org)
Friend of AOMSM ($35)
Donor (Any Amount Welcome)

Please include your name, address, email address and phone number as you would
like them to appear in our database. Please print legibly
Personal Information
Name: _______________________________________________ MA License # : _____________________
Address: _______________________________________________________________________________
Phone: _____________________________________ Fax : _______________________________________
*Email: _____________________________________Website:_____________________________________

Business Information
Name: _______________________________________________MA License #: _______________________
Address: _________________________________________________________________________________
Phone: _____________________________________ Fax : _________________________________________
*Email: _____________________________________Website:______________________________________

Visit us at www.AOMSM.org