Warning: browser cookies disabled. Please enable them to use this website.


* Mandatory fields

Contact Information

*First name
Middle Name/Initial
*Last name
*Primary Email
This email is where all SDSMA communication will be sent to.
Alternate Email
Primary Phone

Work Information

Employment Start Date

Home Information

Home/Cell Number
Home Address
Home Address 1
Home City
Home Zip Code

Personal Information

Date of Birth
Spouse's Name
if applicable
Maiden Name
if applicable
 Payment frequency
*Amount ($USD)
• PAC Contributions & Foundation Donations are counted in the year received.
• Student sponsorship is $100 for 4 years
• Foundation Donations support medical student scholarships
• See above for PAC club levels
Add specific routing for foundation if desired.

South Dakota State Medical Association
2600 W 49th St Ste 100
Sioux Falls, SD 57105
Phone: 605.336.1965 | Fax: 605.274.3274

Powered by Wild Apricot Membership Software