Texas Society of Medical Assistants
TSMA Hurricane Harvey Relief Application
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Harvey Relief Application
TSMA is honored to help our members who need our assistance.  We are accepting requests for relief with professional expenses.  What about assistance with your AAMA Dues Renewal or even attendance to a CEU Meeting/Conference? 

Submit your request here. Each request will be reviewed by the TSMA Executive Board and Harvey Committee.  Awards will be dependent on donations received. 

All requests will be considered on a case by case basis. 

(All submissions will be considered and by submitting your request, you grant TSMA to use your story/name/photos in our newsletters and for submission to AAMA.  All requests will have AAMA Membership verified).
  

Full Name
*
Street Address: *
City
*
State: *
Zip : *
Telephone Number: *
Email Address: *
Chapter: *
AAMA Membership Number: *
How Can We Help:
Uniform Needs (tops, pants, shoes)/Sizes:
How were you effected by Harvey:
 
Relief Fund Donation Form
If you wish to donate to our relief fund for Hurricane Harvey victims, please complete this form and click on submit.  After you submit your information, just click on the PayPal button to make your Donation.  
Name:
Company:
Address
City:
State:
Zip:
Email Address:
Website URL:
Donation Amount:
Other Amount: