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Physician Membership Application
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ISMS membership now gives you a choice!
This application is for ISMS only, with the option to also join your county society if they have opted in for ISMS processing. If you are interested in membership in your county medical society but the option does not appear in the application below, please contact your local county society directly.
*Select the county based on either your practice or residence address.
*After selecting category and county, you will see an overview of dues payment options.
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Include
ISMS Dues
 (required, standard fee)
County Medical Society Dues
 (optional, standard fee)
IMPAC Contribution 
 (suggested/optional)
This is a voluntary contribution for the Illinois Medical Political Action Committee.
For more information, click here.
...Annual Membership Program
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...Continuous Monthly Membership Program
 (monthly payment total, recurring payment plan)
...Continuous Annual Membership Program
 (annual payment total, recurring payment plan)
Continuous Membership Programs:
Continuous Annual Membership will be charged on January 10 of each year. For NEW monthly members, the first debit will occur today. All subsequent payments for Continuous Monthly Membership will occur on the 10th of every month. The selection of ISMS’s continuous membership program requires participants to agree to a minimum 12-month commitment of consecutive membership. Continuous membership may be terminated after 12 months by providing 30 days’ written notice to ISMS.
Please enter your name as shown on the medical license.
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Practice or home address must be in the county to which you are applying.
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Help Us Say Thank You: If your are joining ISMS at the suggestion of a current ISMS member, we would appreciate the opportunity to say thank you. Please indicate the ISMS member that referred you:
Conditions of ISMS Membership and Applications: Members pledge to abide by the ISMS Code of Ethics, Anti-Harassment Policy, and Bylaws. Applicants and members must disclose to the ISMS legal division any fraud or felony convictions; actions taken regarding professional licensure, such as any revocation, suspension, probation, limitation, condition, or sanction; or discipline by any medical society or hospital medical staff. The ISMS is required to report certain professional review actions under state or federal law. The ISMS Code of Ethics and Bylaws can be found at www.isms.org. The ISMS Anti-Harassment Policy can be found at https://isms.org/About_ISMS/Anti-Harassment_Policy/
I am aware that information submitted in this application will be verified. I hereby authorize other organizations having information relating to this application, including governmental and regulatory entities, to release any and all such information. I understand that any false or misleading statement made on my application may be grounds for denial of membership or probation or censure by, or suspension or expulsion from the medical society.
Account Information: You will be sent confirmation of your application approval indicating the total amount charged to your credit card. If you are a practicing physician, please use the following guide as an approximation of your total dues amount or phone (800) 782-ISMS ext. 1900 for your specific total.
Privacy Notice: Illinois State Medical Society is committed to protecting and respecting your privacy. By applying for membership, you agree to receive information from ISMS and its affiliates about the availability of goods, services, membership, and opportunities related to the practice of medicine from ISMS and its affiliates. ISMS does not sell its membership list and that you may opt out of receiving emails or request restrictions on the use of your information by contactingISMS at membership@isms.org or by calling 800-782-4767, ext 1900. A copy of the privacy notice can be found here https://isms.org/About_ISMS/Website_Privacy_Policy/

The foregoing information is true and complete.
Billing Information Summary
Member ID
Full Name
Street Address
Apartment, Suite, etc.
City, State, Zip
Alternate Billing Address
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Dues and Contributions Summary
ISMS Dues
County Dues
IMPAC Contribution
Total
Billing Amount
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This is the date of the first scheduled recurring payment if a continuous payment plan was chosen. If an annual non-recurring plan was chosen, this date becomes the first and only scheduled payment date against the account.
A receipt will be emailed to:  
Illinois State Medical Society

Thank you for joining the Illinois State Medical Society. Your Member ID is: . With your new membership you now have access to a wide range of member's only resources available at www.isms.org.

In 1-2 business days, you will receive an email with instructions on how to activate your account and take immediate advantage of member only content and member discounts the ISMS Education Center.

If you require any assistance please contact us at onlinehelp@isms.org or by phone, toll-free, at 888-476-7776.

Thank you for your membership!

Thank you for joining the Illinois State Medical Society.

With your ISMS membership you will have access to a wide range of member's only resources available at www.isms.org.

A Membership representative will contact you shortly.

Thank you for your membership!

A receipt will be emailed to:  
Payment Confirmation
Illinois State Medical Society
Date/Time:
Customer ID:
Transaction Amount:
Transaction Type:
Status: Pending
Customer Billing Information
Full Name:
Address:
ISMS Member

Our records indicate that you are a current ISMS Member. How would you like to proceed?

If you have any questions, please contact the ISMS Membership Services Department at (800) 782-4767, extension 1900.

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