TMA Membership Transition Form

Are you retiring, leaving the state, or leaving the practice of medicine? Please fill out TMA's Membership Transition Form so that we can have the most up-to-date records regarding membership. Your participation and feedback are appreciated. Thank you for your time and investment as a member of the Tennessee Medical Association.

Fields marked with an * are required.

Name *

Personal Email *

Cell Phone Number *

Home Address *

Address 2 *

City *

State *

Zip Code *

Please provide your NPI number *

Why are you ending your membership with the Tennessee Medical Association? *

I am retiring

I am moving out of the state

I am leaving the practice of medicine

Other

If you responded with "other" on the above question, please provide a short reason why.

What date are you leaving the practice, leaving the state, retiring, or other? *

Please provide any comments you would like to pass along regarding your experience with the TMA.

TMA Membership Transition Form

Please verify that you have checked the “I'm not a robot” checkbox.

Is Your Voice Represented? Join TMA and Gain the Support You Deserve.