SOMSA Life Membership Application

First Name *

Last Name *

Years in OMS (deprecated) *

What year did you join SOMSA/JAWS Society, to the best of your recollection? *

Why are you requesting Life Membership? *

Retiring
Disability
Termination
Leaving OMS

Please provide more detail about your request for Life Membership for the Membership Committee to consider. *

Neon CRM by Neon One

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