Contact: ucfa.ca

TO PROTECT YOUR RIGHTS AND HAVE A VOICE, join the Section of Clinical Faculty. We make it easy!

Membership and Dues Information

As a member or potential member of clinical faculty in the UBC Faculty of Medicine, you are eligible to join the BCMA Section of Clinical Faculty (formerly the University Clinical Faculty Association or UCFA). There are three ways you can join:

Join the Section at the same time as you renew your BCMA
dues
Print out this page, fill it in and mail it with your
payment to
- Ms. Diane Wong, c/o BC Medical Association,
  #115 - 1665 West Broadway, Vancouver, BC V6J 5A4.
MOST EASILY: Fill out the form below, including your
credit card information, and click "Submit." You will be
signed up electronically. (Your credit card information will
be completely secure).

Annual Dues: $120 Please make your cheque payable to Section of Clinical Faculty and mail with this form to:

Ms. Diane Wong
c/o BC Medical Association
#115 - 1665 West Broadway
Vancouver, BC V6J 5A4

CONTACT INFORMATION: ALL FIELDS MUST BE FILLED OUT.
First Name: Last Name: Email: Phone:	Address: City: Province: Postal Code:
University Appointment: (eg., Clinical Instructor). Hospital / Department Affiliation:
Are you interested in an active role in the BCMA Section of Clinical Faculty? Would you consider serving on: Executive Subcommittees or as Helper?
CREDIT CARD & PAYMENT INFORMATION
Paid with BCMA due Payment Option:	Credit Card Number: Expiry: (mm/yy) / Pin Number (back of credit card): Name on Card:
Any Questions or Comments? * required

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