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Mütter Museum Hours
Daily, 10am to 5pm


College Office Hours
Mon-Fri, 9am to 5pm

Fellowship and Section Dues Payment Form
Fellow Information
Title/Prefix
*First Name Middle Initial *Last Name Suffix
Organization
Position/Title
*Email Address
Detail about your Dues
 
*Fellowship Dues:
$
New Fellows Initiation Fees:
$
  *Note: Fellowship dues are tax-deductible, irrespective of your employment or retirement status.
If you are ONLY paying SECTION DUES, you MUST ENTER $0 in the "Fellowship Dues" field.
 
  Section Memberships
 
Section on Medical History
($40)  
 
Section on Medicine & The Arts
($40)
 
Section on Public Health and Preventive Medicine
($40)  
 
Section on Medicine, Ethics & the Law
($40)
 
Additional tax-deductible contribution to The College
of Physicians’ Annual Giving Program
$
 
My employer will match my contribution
 
 
Total amount will appear on the next page.
 
Please complete the following information for the person completing this form (if different than above)
 
Same as Above
   
 
Contact
 
 
Email Address
 
 
Telephone