Become a Member - Polish-American Medical Society

Membership
Individual

$205⁰⁰
Yearly

Membership
Couples

$307⁰⁰
Yearly

Membership
Residents, retired physicians

$102⁰⁰
Yearly

Membership
Medical students

$61⁰⁰
Yearly

MEMBERSHIP APPLICATION

Please fill out the application form below. At the bottom of the application, you will have some payment options:

• You do not need to have a PayPal account to submit your payment.

• If you submit an application on behalf of other members associated with your business, mark Business option and list names of all the applicants.

• Processing fees are already included.

We are a 501-c-3 organization. Your membership fee may qualify as a tax deduction as permitted by the law.

Membership Application

MEMBERSHIP APPLICATION

"*" indicates required fields

Name

Title First Last

Type of Membership
You must be a Physician to be considered for a regular PAMS membership. Are You an MD, DO, DDS, DPM, DVM, MD/PhD or Medical Student?

Who i am

I am a Physician or Medical Student - Applying for a Regular Membership

I am not a Physician - Applying for an Associate Membership

Home Address

Adres

Email *

Email*

Country of Brith *

Country of Birth*

Name of Medical School *

Name of Medical School*

Year of Graduation *

Year of Graduation*

Residency and Fellowship *

Current Workplace*

Specialty and Appointments

Specialty and Appointments

Current Workplace *

Current Workplace*

First and Last Name of Spouse or Partner
Required only for couples discount

First Name of Spouse

Yearly Membership Dues
After Submitting the form, you will be redirected to PayPal where you will pay the yearly membership dues with any major credit or debit card. Processing fees are already included.

Membership

Individual $205.00

Couples $307.00

Residents/Retired Physicians $102.00

Medical Students $61.00

Name

First Last

Email

Name

First Last

Email

ATTENTION:

To be included in our complimentary Clinician Directory, please click this link and sign in to your Google account to complete the Directory application.

Date

Business or Private

Private

Business

Campany Name

Purchase Membership for your Employees

Price: $205.00

Employees

Name

Surname

Payment Options*

ATTENTION: if you have issues paying by credit card directly, please click "Want to pay online," then select PayPal Checkout as a card Payment Method below, (no PayPal Account is necessary for most countries, just deselect the"create your PayPal account" button when navigating through prompts.)

Want to pay online

Please mail your checks to: Polish American Medical Society, 1450 W Lake Street, Suite 101, Addison , IL 60101

Please send your Zelle payment to: pams@zlpchicago.org

Online Processing Fee

$0.00

Membership and Fees

Total

Payment Method

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name