SCMS Member Correction Form


Every year the Spokane County Medical Society publishes a Pictorial Directory for our members and local businesses.  We publish two editions: the Physicians Edition and Business Edition.  It is very important that the information in this publication is correct.  If you are moving or your listing is incorrect, please use the following form to correct or add information.  Please note: the business edition of the pictorial directory does not list your personal information such as home address & phone, spouses name or e-mail.

If you have a new photo to be included in the pictorial directory you may mail it to: SCMS, Attention Pictorial Directory Staff, 104 S. Freya St., Orange Flag Building #114, Spokane, WA 99202 or you may email it to stacey@spcms.org.  The photo should be a black & white photo, at least 2"x3" in size.  If you should send in electronic form, please make sure that the file is in either a .tif, .gif or .jpeg format and that the resolution is at the minimum 300 dpi.  The deadline for photos and changes to be made for the next years edition is in March of each year.  The directories are then made available to members in June.

Thank you for your cooperation in making the Spokane County Medical Society's Pictorial Directory a excellent source of information.

[FrontPage Save Results Component]

Please provide the following contact information:

Full Name:          

Title:                     

 

Medical School: 

Graduation Year:

Board Certified In:

(list all AOA & ABMS certifications only)

 

Specialty: (list all specialties you practice)

 

Office #1 Information

 

Group Affiliation:

Office Address:

Phone:

Address Cont.:

Fax:

City:

 

 

State:

Zip:

 

 

Office #2 Information

 

Group Affiliation:

Office Address:

Phone:

Address Cont.:

Fax:

City:

 

 

State:

Zip:

 

 

Home Information

(only published in physician edition)

Home Address:

Phone:

Address Cont:

Fax:

City:

Spouse:

State:

Zip:

Email:

 


Copyright © 2003 Spokane County Medical Society. All rights reserved.
Revised: 12/21/04