Please fill in your membership information 
and then click here to pay your dues.
*First Name:
*Last name:
*E-mail Address:
*Spouse's Name
 Spouse's Specialty or Profession
*Street Address:
*City:
 Zip Code
 County
*Phone:
*Areas of Interest:   Community Health Projects
  Social Support Network
  Health Related Poltical Action
  Leadership/Personal Growth
 Hobbies, Special Interests
 Professional Degrees/Skills
 Occupation
 Dues Payment: Please select a membership catagory or area of residence for dues payment   I live in Larimer County: dues are $95
  I live in the Longmont area: dues are $75
  I live in Mesa County: dues are $90
  I live in Metro Denver: dues are $75
  I live in the San Luis Valley: dues are $75
  I am a Resident Physican/Spouse: dues are $22.50
  I am a medical student/spouse dues are $22.50
  Member at large: I live in any area other than those listed above: dues are $60
 Thank you for filling in your membership info. To pay your dues click on the link at the top of the page or please visit the "Pay Dues Online" page by clicking on its tab to the left.
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