Individual Student

Membership Registration

Thank you for joining or renewing as a Student. We are excited to have you as part of MDG Boston!

Your Profile is hidden from other members, unless you opt into the new Member Directory.

If you choose to join it, you can connect with colleagues and promote your services and/or products. For the Member Directory, minimal profile information is provided – you can fill or leave blank each of these optional fields:

Avatar (uploads must be <600 Kb)
Town
State/Province
Email
Phone
Website
LinkedIn
~100 word Profile (Professional or Organization), where you can describe your business interests and provide useful search terms

Your choices can be revised within your Profile at any time

Terms:

$25 / Year

First Name:* First Name Required

Last Name:* Last Name Required

Address Line 1:* Address Line 1 is Required

Address Line 2: Address Line 2 is not valid

City:* City is Required

Country:* Country is Required

State/Province:* State/Province is Required

Zip/Postal Code:* Zip/Postal Code is Required

Company, Organization, or School (if student):* Company, Organization, or School (if student) is Required

Title or Role:* Title or Role is Required

Preferred Pronouns (OPTIONAL): Preferred Pronouns (OPTIONAL) is not valid

I want to be included in the Member Directory (YOU CAN SELECT WHICH FIELDS TO DISPLAY BELOW):* I want to be included in the Member Directory (YOU CAN SELECT WHICH FIELDS TO DISPLAY BELOW) is Required

YES NO

Member Directory Profile (Professional or Organization - 100 word limit - OPTIONAL, BUT RECOMMENDED): Member Directory Profile (Professional or Organization - 100 word limit - OPTIONAL, BUT RECOMMENDED) is not valid

Linked In (OPTIONAL, BUT RECOMMENDED): Linked In (OPTIONAL, BUT RECOMMENDED) is not valid

Town (LEAVE BLANK IF NOT WANTED IN DIRECTORY): Town (LEAVE BLANK IF NOT WANTED IN DIRECTORY) is not valid

State/Province (LEAVE BLANK IF NOT WANTED IN DIRECTORY): State/Province (LEAVE BLANK IF NOT WANTED IN DIRECTORY) is not valid

Email (LEAVE BLANK IF NOT WANTED IN DIRECTORY): Email (LEAVE BLANK IF NOT WANTED IN DIRECTORY) is not valid

Phone (LEAVE BLANK IF NOT WANTED IN DIRECTORY): Phone (LEAVE BLANK IF NOT WANTED IN DIRECTORY) is not valid

Website (LEAVE BLANK IF NOT WANTED IN DIRECTORY): Website (LEAVE BLANK IF NOT WANTED IN DIRECTORY) is not valid

Volunteering Opportunities to help us carry out our mission (please email volunteer@mdgboston.org to learn more): Volunteering Opportunities to help us carry out our mission (please email volunteer@mdgboston.org to learn more) is not valid

Username:* Invalid Username

Email:* Invalid Email

Password:* Invalid Password

Password Confirmation:* Password Confirmation Doesn't Match

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Coupon Code:

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Description	Amount
Individual Student – Initial Payment	$25.00
Total	$25.00

Select Payment Method

Stripe Pay by check

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Please send check to: Medical Development Group of Boston POB 555 | Concord, MA 01742

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