Please complete and submit to Baja California Medical Tourism Association
Organization
Individual
Name
President/Owner
Address
Postal Code
City
Country
Telephone
Fax
Email
Website
Invoice To
Billing Contact
Administrator
After receipt of this registration, a questionnaire will be sent to you to fill out. Upon receipt of questionnaire and any subsequent questions, membership will be notified and within two weeks membership dues will be invoiced. Dues are payable within one week from invoice date for membership to become effective.
Membership dues (Mark the one that applies to you):
Hospital Membership $2,500.00
Specialty Clinic Membership $2,000.00
Private Practice Doctor Membership $300.00
Independent (non-hospital) pharmacy multi locations $500.00
Independent (non-hospital) pharmacy single location $500.00
Government/Healthcare Cluster Membership $1,000.00
US Health Insurance Carriers Corporate Membership $3,000.00
Medical Tourism Facilitators Membership $1,500.00
Travel Agencies Membership $1,500.00
Medical Supply/Pharmaceutical Companies Membership $5,000.00
Associate Membership Business $500.00
Associate Member Individual $200.00
