FAAMA Application Form APPLICATION FOR FELLOWSHIP DESIGNATION Fellow, National Arab American Medical Association (FAAMA) Fellowship in NAAMA is an honor. Being an FAAMA is a distinction earned from colleagues who recognize your accomplishments and achievements over and above the practice of medicine. The most important considerations for NAAMA Fellowship are excellence and contributions made to both NAAMA and to the broader community. To be a Fellow, National Arab American Medical Association (FAAMA), a candidate must: 1) Be an Active-category member in good standing for three years of more and 2) Active involvement in NAAMA at the Chapter level and/or 3) Active involvement in NAAMA at the National level and/or Recognition of active community service.Contact InformationFirst Name*Last Name*Date of Birth* Gender* Male Female Degree*Office Address*City*State/Province*Zip/Postal Code*Office Phone*Email*Home Address*City*State/Province*Zip/Postal Code*Home PhoneCell PhoneMembership ActivityChapter you belong to*Year you joined NAAMA*Number of years of continuous membershipDetailed Activities with NAAMA (Chapter)Detailed Activities with NAAMA (National)Total Contributions to the NAAMA FoundationPAYMENT OPTIONS Fellowship Application Fee $125.00 Please check one:* Credit Card Check Card Holder Name*Card Type*Please select from drop down menuVisaMasterCardPaypalCard Account Number*Expiration Date (MM/YYYY format)*Transaction Amount:*CONFIRM Transaction Amount:*Please make sure your transaction amount matches. Please make your check payable to: NAAMA Mail your payment to: NAAMA National Office, 2265 Livernois Road, Suite 720, Troy, MI 48083 Make sure to SUBMIT this form before mailing check. Billing Address*City*State/Province*Zip/Postal Code*Signature*All information provided above is accurate to the best of my knowledge. This electronic form qualifies as an electronic signature on my behalf.* I agree Your application will be reviewed by the Executive Committee and will be notified as soon as possible. For questions, please contact NAAMA Executive Director, Renee Ahee at 248-646-3661 or firstname.lastname@example.org.