Membership Form
999 N. Curtis, Ste. 516, Boise, ID 83706
Phone: (208) 367-2224  •  Fax: (208) 367-3167

How To Join
Complete the following On-Line Membership Application Request Form and submit it.  A new account packet will come to you in the mail with required membership documentation. 

Applicant Information
First Name: MI: Physical Address :
Last Name: City : State:
Date of Birth: Zip :
Mother's Maiden Name: Mailing Address :
Social Security #: City : State:
Email Address : Zip :
Home Phone : Driver’s License # :
Business Phone : Driver License Issue Date :
Cell Phone: Driver License Expiration Date :
Employer: Driver License State of Issue :
Occupation / Title:    

Membership Eligibility (Check all that apply)
Saint Alphonsus Health System:
Boise      Nampa       Ontario       Baker City
Live, Work, Volunteer in Healthcare / Ada County
Related to Current Member

Joint Applicant Information
First Name: MI: Email Address :
Last Name: Physical Address :
Date of Birth: City : State:
Mother's Maiden Name: Zip :
Social Security #: Home Phone :
Driver’s License # : Cell Phone :
Driver License Issue Date : Work Phone : Ext.
Driver License Expiration Date : Employer:
Driver License State of Issue :    

Beneficiary Designations
Payable on Death (POD) Account
Beneficiary / Payee: Beneficiary / Payee:
Street: Street:
City / State / Zip: City / State / Zip:
Phone Number: Phone Number:

Submit Application

I hereby make application for membership in Saint Alphonsus Medical Credit Union (SAMCU), and agree to conform to its bylaws and amendments thereof, and to subscribe for at least one (1) share. SAMCU is hereby authorized to recognize any of the signatures subscribed hereto in the payment of funds or the transaction of any business for this account. The joint owners of this account hereby agree with each other and with SAMCU that all sums now paid in on shares, or heretofore or hereafter paid in on shares by any or all of said owners to their credit as such joint owners with all accumulations thereon, are and shall be owned by them jointly.


By pressing the "Submit Application" button below, you agree to the above statement and that you acknowledge that you have read and agree to the Share Account Agreement .