Silver Caduceus Association

Fill out the membership form below and click the "Continue" button to get started with a new membership or membership renewal.

First Name *

Last Name *

Primary Email *

Primary Phone *

* Note that a personal email is preferred over a work email.

Military Status *

Military Rank *

Membership Length *

New Membership or Renewal *

I am renewing an existing SCA membership.

I am registering and paying for a new SCA membership.

* Note that a $10 admin fee is applied to all new memberships.

Street Address *

Suite/Apt

City *

State *

Zip *

Home Phone

Cell Phone

Work Phone

Service From Date * * Format is MM/YYYY

Service To Date * * Format is MM/YYYY

Primary AOC *

Spouse's Name

Do you authorize the use of your name or photo for use in SCA publications? *

YES, I DO authorize the use of my name or photo for use in SCA publications.

NO, I DO NOT authorize the use of my name or photo for use in SCA publications.

Applicant's Signature *

Application Date * * Format is MM/DD/YYYY