What CMA has done for Medical Students:

What CMA has done for Medical Students: Organized medicine s commitment to the future of our field CMA, representing 39,000 physicians, influences public policy at the federal and state level. Join today to activate your personal web account at www.cmanet.org CMA membership is free for medical students and only a phone call away! Our live-person call center is available Mon-Fri during business hours at 800-786-4262. Student Leadership CMA hosts multiple statewide events teaching students medical policy, leadership skills and the importance of legislative advocacy. - 2014 Western Health Care Leadership Academy, April 11-13, 2014 Medical students and residents hold elected seats on CMA s Board of Trustees and House of Delegates. Reimbursement/Economic CMA stopped a 24 percent Medicare payment cut that would have discriminated against California physicians and its medical institutions. CMA s lobbying efforts in Washington D.C. were instrumental in updating California s outdated Medicare payment localities, which will increase payments to physicians in 14 counties by $50 million annually and over $400 million in the next decade. Dedicated to student advocacy CMA has sponsored legislation to increase medical student scholarships. CMA is fighting in the California Legislature, as well as Congress, to secure more funding for Graduate Medical Education (residency funding). California is one of a few states to have its own medical school loan repayment program, the Steven Thompson Loan Repayment Program, named after long-time CMA advocate Steve Thompson. Elected student leaders of CMA s Medical Student Section have ample opportunity to attend various CMA/AMA conferences. Physician Leadership CMA s educational team has presented more than 45 webinars and seminars to over 4,800 participants in 2013, covering topics that include federal health care reform, electronic health records (EHR) and better business practices. For the past 17 years, CMA has hosted the state s Health Care Leadership Academy, the premier leadership training program for California physicians. In 2014, the conference expanded to include participation from nearby states, being rebranded as the Western Health Care Leadership Academy. Annually, CMA brings together more than 800 physicians leaders for multi-day policy debate at our House of Delegates conference, which has set the association s policy direction for roughly 150 years. For more information about CMA and its programs visit www.cmanet.org Rev. 4.3.14 Page 1 of 1

SmartLaw The Smart way to FIND A QUALIFIED LAWYER AND GET FREE LEGAL INFORMATION 213.226.0377 The LACMA Lawyer Referral Program is administrated by the Los Angeles County Bar Association (LACBA) and powered by LACBA SmartLaw, the model referral system in the nation. Now, in an exclusive offering, LACMA brings this benefit to its members. The service is free and each LACMA member will receive a free consultation. All attorneys are continuously screened and vetted by LACBA. HOW IT WORKS: 1 3 Call (213) 226-0377, LACBA s exclusive line for LACMA physicians. 2 Speak with a LACBA representative, to discuss your legal issue and find a lawyer in your area. You must identify yourself as a member of the Los Angeles County Medical Association. LACMA Members are guaranteed: Free lawyer referral Free 30-minute consultation with the lawyer* *This services does not provide free, pro-bono legal services. All attorneys charge fees after the consultation. Strict Quality Assurance/Quality Control (QA/QC) standards for lawyers who are referred through LACBA s Smart Law system To learn more about this member benefit, including the strict QA/QC process, please visit www.lacmanet.org/lawyerreferral A service of Los Angeles County Bar Association

It is a tremendous honor and privilege to practice medicine. Being born in Cuba, I know first hand how important access to quality care is, as well as a physician s autonomy to treat patients without government or corporate interference. Without an organization like LACMA and CMA, we would otherwise have no voice in Los Angeles County. With a thriving practice, I know how busy physicians can get and sometimes joining another association can seem like a waste of time and money. I can tell you from experience that LACMA offers a long list of tangible and practical benefits that give us immediate return on investment as well as a long lasting proven commitment to fighting for and preserving our profession. My dues were immediately paid for through the savings I receive from LACMA s Preferred Partnership programs alone. Thank You for joining me and 6,000 other physicians and making our voices heard loud and clear. Thank you for joining LACMA! Respectfully, Dr. Carlos Martinez Your Success. Our Passion. WWW.LACMANET.ORG LOS ANGELES COUNTY MEDICAL ASSOCIATION 707 WILSHIRE BLVD, SUITE 3800 LOS ANGELES, CA 90017 FAX: (213) 226-0353 With over 6,000 members from all specialties, the Los Angeles County Medical Association is your premiere physician organization. Together with the California Medical Association, LACMA advocates for quality healthcare, defends the physician-patient relationship, and serves the professional needs of its members. www.lacmanet.org PERSERVERANCE INTEGRITY EXCELLENCE

One Choice, Two Organizations: Fighting for You Together We Are Stronger LACMA & CMA put your membership to work! LACMA and CMA provide physicians the platform to shape the future of healthcare. When you join LACMA, you join CMA a powerful coalition uniting over 40,000 physicians across California. Every member that joins strengthens CMA s position at the negotiating table, ensuring that physicians voices are heard. Current and ongoing advocacy efforts: Protecting MICRA & Tort Reform Fair Payment for Medicare / Medi-Cal Patients Limiting the expansion of Scope of Practice Increasing educational opportunities for future physicians in California Tired of Payor Intimidation? LACMA and CMA are distinguished by their successes. Dual membership provides for unparalleled legislative advocacy to end abusive practices. In addition, LACMA has sued health care plans on behalf of members to stop intimidation tactics. 27% in Average Savings Through an exclusive partnership with Medline, LACMA saves members a guaranteed minimum of 10% on their medical supplies and equipment. Find out how one member saved $31,000 for his practice! CMA Gets YOU Paid! Raise Your Bottom Line Tired of fighting with payors? CMA s Economic Services experts recovered over 7.8 million dollars for members since 2010. Aimed at meeting both your professional and personal needs, LACMA offers you additional discounts and savings on Auto & Home Insurance, UPS services, Staples office supplies, Financial Planning, HIPAA Compliance Kits, and more! PLEASE CALL 888-401-5911 $7.8 million FREE Jury Duty Assistance LACMA CAN HELP YOU: Reschedule your date Relocate for your convenience Reduce number of call-in days from 5 to 1! PLEASE CALL 213.226.0361 Unlimited Access to Legal Experts Save time and money by consulting with a CMA legal expert before hiring a lawyer. Services include HIPAA Compliance, ACOs, buying and selling a practice, upkeep of medical records, contract analysis, and much more! Network with Key Leaders Socialize and network with members of the medical community Find or create opportunities for your practice Engage with legislators and policymakers State-of-the-Art Communication Information is power. LACMA and CMA produce several publications including the awardwinning Physicians Magazine and Physicians News Network all full of tips and tools for you practice. Essential Resources for Success Access to your Physician Advocates CMA develops toolkits, guides, webinars, and resources to help you navigate today s changing healthcare landscape. In addition, LACMA and CMA provide you access to timely and informative CME-accredited events all at your fingertips. When you join LACMA and CMA, you hire a professional staff that serves as an extension of your practice. We are here to help you reach your goals and connect to the resources you need most. Whatever you need be it legal information, help with a problematic payor, or details about your member discounts just call the member helpline at (800) 786-4262 or visit cmanet.org Improve Your Professional & Personal Success, join NOW For more information on member benefits and resources, visit www.lacmanet.org/membership or call (213) 226-0356

MEMBERSHIP APPLICATION Complimentary Membership for Interns, Residents, & Fellows SECTION ONE DEMOGRAPHIC INFORMATION Name (As Shown on CA MD/DO License) CA MD/DO License # (if applicable) Date of Birth (mm/dd/yyyy) E-mail Address Street Address City Phone number State Zip Code SECTION TWO MEMBERSHIP INFORMATION I am: Intern Resident Fellow Internship/Residency/Fellowship Location: Reason(s) for joining LACMA (Check all that apply): Networking Opportunities Leadership opportunities Specialty: Expected Graduation Year: Discounts & Services Other (please describe): Los Angeles County Medical Association 707 Wilshire Boulevard Suite 3800 Los Angeles, CA 90017 TEL: (213) 226-0313 FAX: (213) 226-0353 www.lacmanet.org Like us on Facebook: www.facebook.com/lamedicalassn Follow us on Twitter: @LaMedicalAssn MEMBERSHIP APPLICATION Complimentary Membership for Interns, Residents, & Fellows SECTION ONE DEMOGRAPHIC INFORMATION Name (As Shown on CA MD/DO License) CA MD/DO License # (if applicable) Date of Birth (mm/dd/yyyy) E-mail Address Street Address City Phone number State Zip Code SECTION TWO MEMBERSHIP INFORMATION I am: Intern Resident Fellow Internship/Residency/Fellowship Location: Reason(s) for joining LACMA (Check all that apply): Networking Opportunities Leadership opportunities Specialty: Expected Graduation Year: Discounts & Services Other (please describe): Los Angeles County Medical Association 707 Wilshire Boulevard Suite 3800 Los Angeles, CA 90017 TEL: (213) 226-0313 FAX: (213) 226-0353 www.lacmanet.org Like us on Facebook: www.facebook.com/lamedicalassn Follow us on Twitter: @LaMedicalAssn

MEMBERSHIP APPLICATION SECTION ONE DEMOGRAPHIC INFORMATION Name (As Shown on CA MD/DO License) CA MD/DO License # Date of Birth (mm/dd/yyyy) E-mail Address Phone number Street Address City State Zip Code SECTION TWO MEMBERSHIP & PAYMENT INFORMATION Membership Type (please check one): First-time member: $555 (Full dues reached by year 3) Young physicians: $319 (Full dues reached by year 5) Former member: $1,150 (Full dues) Resident physicians: Free Sign me up for a LACMA-CMA membership for the duration of my Internship/residency/post-grad programs in LA County Medical Students: Free Referred by: Annual Membership dues will be renewed automatically to this card according to your respective dues program. To opt out of auto-renew, please check here Card Type (please check one): MasterCard Visa American Express Account Number Expiration Los Angeles County Medical Association 707 Wilshire Boulevard Suite 3800 Los Angeles, CA 90017 TEL: (213) 226-0313 FAX: (213) 226-0353 www.lacmanet.org MEMBERSHIP APPLICATION SECTION ONE DEMOGRAPHIC INFORMATION Name (As Shown on CA MD/DO License) CA MD/DO License # Date of Birth (mm/dd/yyyy) E-mail Address Phone number Street Address City State Zip Code SECTION TWO MEMBERSHIP & PAYMENT INFORMATION Membership Type (please check one): First-time member: $555 (Full dues reached by year 3) Young physicians: $319 (Full dues reached by year 5) Former member: $1,150 (Full dues) Resident physicians: Free Sign me up for a LACMA-CMA membership for the duration of my Internship/residency/post-grad programs in LA County Medical Students: Free Referred by: Annual Membership dues will be renewed automatically to this card according to your respective dues program. To opt out of auto-renew, please check here Card Type (please check one): MasterCard Visa American Express Account Number Expiration Los Angeles County Medical Association 707 Wilshire Boulevard Suite 3800 Los Angeles, CA 90017 TEL: (213) 226-0313 FAX: (213) 226-0353 www.lacmanet.org

MEMBERSHIP APPLICATION SECTION ONE DEMOGRAPHIC INFORMATION Name (As Shown on CA MD/DO License) CA MD/DO License # Date of Birth (mm/dd/yyyy) E-mail Address SECTION TWO: CONTACT INFORMATION Office Contact Information Home Contact Information Medical Group Name: Street Address: Street Address: City: State: Zip: City: State: Zip: Phone: Fax: Phone: Fax: Office Manager s Name: Office Manager s E-mail Address: My Preferred LACMA/CMA Contact Location Office Home SECTION THREE EDUCATION & TRAINING Practice Information Specialty: Solo/Small Group (1-4) Academic Internship Location: Years: Medium Group (5-149) Hospital-based Residency Location: Years: Large Group (150-999) Government-employed Postgraduate/Fellowship: Years: Very Large Group (1,000+) Administrative Medicine Referred by: SECTION FOUR ATTESTATION & MEMBERSHIP TYPE IMPORTANT: PLEASE CHECK BEFORE PROCEEDING The foregoing is true and complete, and I endorse the Principles of Medical Ethics of LACMA-CMA (available at cmanet.org). By providing the fax number and e-mail address on this application, I agree to receive important fax and e-mail communications for the association. Membership Type (please check one): First-time member: $555 (Full dues reached by year 3) Young physicians: $319 (Full dues reached by year 5) Former member: $1,150 (Full dues) Resident physicians: Free Sign me up for a LACMA-CMA membership for the duration of my Internship/residency/post-grad programs in LA County Payment Type (please check one): My check is enclosed for my LACMA-CMA membership. (Please make checks payable to LACMA) Please charge my dues to my credit card. Annual Membership dues will be renewed automatically to this card according to your respective dues program. To opt out of auto-renew, please check here Card Type (please check one): MasterCard Visa American Express Account Number Expiration Medical Students: Free Los Angeles County Medical Association 707 Wilshire Boulevard Suite 3800 Los Angeles, CA 90017 TEL: (213) 226-0313 FAX: (213) 226-0353 www.lacmanet.org

Benefits & Discounts Aimed at meeting both your professional and personal needs, LACMA offers you additional discounts and savings on Auto & Home Insurance, UPS services, Staples office supplies, Financial Planning, HIPAA Compliance Kits, and more! five 6 TOP10 REASONS FOR JOINING LACMA AND CMA FREE CME & Educational Resources CMA develops toolkits, guides, webinars, and resources on all things related to today s changing healthcare landscape all FREE with membership. In addition, LACMA provides access to important and local CME-accredited events. Working together, the Los Angeles County Medical Association and the California Medical Association are strong advocates for all physicians and for the profession of medicine. Of the many reasons for joining LACMA and CMA, 10 stand out. Unlimited Access to Legal Experts Save time and money by consulting with a CMA legal expert before hiring a lawyer. Services include HIPAA Compliance, ACOs, Buying and selling a practice, Upkeep of medical records, and much more! seven LACMA/CMA IS THE VOICE OF PHYSICIANS 8 1Legislative Advocacy LACMA and CMA are distinguished by their successes. Dual membership provides for unparalleled score FREE Networking & Referral Events Socialize and network with members of the medical community Find or create opportunities for your practice Engage with legislators and policymakers legislative advocacy to end abusive practices. In addition, LACMA has sued health care plans on behalf of members to stop intimidation tactics. State-of-the-Art Communication Information is power. LACMA and CMA produce several publications full of valuable information including the award-winning Physician Magazine, Physicians News Network, and CMA Practice Resources, full of tips and tools for your practice. 9 Reimbursement Assistance Tired of fighting with payors? CMA s Economic Services experts have recovered twofree nearly $8 million for members since 2010! Jury Duty Assistance LACMA can help you: Reschedule your date Relocate for your convenience Reduce number of call-in days from 5 to 1! 3 FREE tenaccess to your Physician Advocates When you join LACMA and CMA, you hire a professional staff that serves as an extension of your practice. We are here to help you reach your goals and connect to the resources you need most. Whatever you need be it help with a problematic payor, or details about your member discounts just call the member helpline at (800) 786-4262 or visit www.lacmanet.org 27% in AVERAGE SAVINGS Through an exclusive partnership with Medline, LACMA saves members a guaranteed minimum of 10% on their medical score supplies and equipment. Find out how one saved $31,000 for his practice! 4 member RIGHT NOW is the best time to join LACMA and CMA For more information on member benefits and resources, visit www.lacmanet.org/membership LOS ANGELES COUNTY MEDICAL ASSOCIATION 707 WILSHIRE BLVD, SUITE 3800 LOS ANGELES, CA 90017 PHONE: (213) 683-9900 FAX: (213) 226-0353

Network Referral Questionnaire On a daily basis, we receive phone calls from patients seeking referrals from LACMA. Please help keep our records updated and give us your feedback on the event. Thank you. Personal Information Name: Phone #: Specialty: CA MD/DO License #: E-mail: Languages Spoken: Practice Information Hospital Affiliations (Please List): Current In-Network Healthcare Plans (Please List): Medical Groups & IPAs (Please List): Office Manager Name: OM Phone #: Website: OM Email: I am a (select all that apply): LACMA Member Physician Solo Physician (1-4 physicians) Group Physician in a Small-Size Group (5-19) Medium-Size Group 50-99 100-149 Hospital-based Physician Practice Manager Clinic Administrator Facility Medical Director/Administrator Government-employed Physician Academic Large Group (150-999) Very Large Group (1,000+)

Member Satisfaction Survey How would you rate this event? Poor Very Effective How familiar are you with all of LACMA s benefits dfor more information on our benefits please visit www.lacmanet.org/mvideo 1 2 3 4 5 6 7 8 9 10 No Knowledge Very Familiar Here is a brief reminder of our Top Ten benefits If you would like more information about a specific benefit, please select the corresponding box: Legislative Advocacy Free Reimbursement Assistance Free Jury Duty Assistance Medline (Supply & Equipment Discounts) Additional Savings & Discounts Educational Resources & Free CME Free Legal Assistance Networking & Referral Events Publications/Informative & Relevant News Access to a Physician Advocate How likely are you to recommend that a colleague join LACMA?*Required 1 2 3 4 5 6 7 8 9 10 Unlikely Very Likely Name and Contact information of referral(s): Any other notes or comments on the event or on LACMA that you would like to share Feel free to include successes, challenges, areas for improvement and other areas where you would like to see LACMA more involved. Featured Member Benefit Medline Supplies LACMA members are saving an average of 27% across all medical supplies by ordering through our exclusive program. Please text Rosario Ortega, LACMA s Physician Advocate, right now at 213-503-3405, if you would like him to follow up with information on how you can save thousands of dollars