Jacksonville Sports Medicine Program

JOIN NOW - STEP 2 - Student Registration

Please fill out the following form to become a member of Jacksonville Sports Medicine Program. Payment options for registration include all major credit cards via Paypal.

Name:

Credentials:

Company/Business Affiliation:

School Association(s):

Mailing Address:

City, State, Zip:

Phone:

Fax:

E-mail:

Would you like your name, company, and contact information to be included on our web site?

Members Only web site
Yes
No

Public Access web site

Yes
No

What are your interests?

Committee Involvement

Speaker's Bureau

Volunteer Coordinator

Elected Officer

Public Relations

"Fund Raising

Entertainment

Other (explain):

Founding Sponsors - Jacksonville Sports Medicine Program