UMMC Alliance

Support UMMC Alliance

Thank you for your interest in the UMMC Alliance! There are two payment options for joining the Alliance or renewing your membership. Select the "Cash or Check" option, complete and print the registration form and mail it along with the total payment to the address provided. If you prefer to pay by credit card, select the "Credit Card" option, fill in the credit card information, and hit the Submit button to process your request.

Cash or check - Print the completed form, attach a check payable to UMMC Alliance and mail to:
  • UMMC Alliance
    Attn: Jonathan Albert
    2500 N. State St.
    Jackson, MS 39216

For more information, email us.

 

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* = Required Fields

First Name* 
Last Name* 
Email Address* 
Phone Number*() -   
Street Address* 
City* 
State*
Zip*- 
Art Acquisition 
General Alliance Foundation 
Patient Needs 
University Support 
Total Payment Amount

Credit Card Payment

Card Holder Name*
Card Type*
Credit Card Number*
Credit Card Expiration Date*
Credit Card CVV Number*
Located on the back of the card