Pay Your Fees

Pay Your Fees for Medical Staff Membership Online
Physician Information (required fields are indicated with *)

Full Name (e.g. Dr. John M. Smith)

Please enter the full name(s) for whom payment is being provided If you are paying for multiple people, please choose "Make a Custom Payment" from the payment options below.
Payment Type
Name on Credit Card
Your 16 digits credit card number.
Your 3 or 4 digit security code on the back of your card.
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.