Request to Join Partner Program

Maricopa County Medical Society (MCMS) welcomes companies offering products and services for physicians to apply for our Partners Program. We have four levels: Advertising Partner, Discount Partner, Preferred Partner, and Exclusive Partner. Please complete the fields below to be considered by our team at MCMS.

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* 1. Please provide some contact information.

Name

Company

Address

City/Town

Email Address

Phone Number

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* 2. Summary of the product or service you provide.

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* 3. Which medical specialties fit your target audience?

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* 4. Are you offering a discount for MCMS member physicians?

Yes

No

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* 5. Upload document # 1 about your product/service.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

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* 6. Upload document #2 about your product/service.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.