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ASSOCIATE MEMBER $200.00
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Additional Information
Additional Information
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By submitting payment, I am authorizing Medical Association of Southeast Louisiana to initiate a single or recurring ACH/electronic debit in the amount indicated from the bank account I designated above. I understand that this Authorization will remain in full force and effect until the transaction is cancelled by me by contacting Medical Association of Southeast Louisiana, or the ACH/electronic debit is processed from the designated account. I certify that (1) I am authorized to debit the bank account above and (2) the ACH/electronic payment I am authorizing complies with all applicable laws.
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