Become a Resident Member

MD/DO Resident Membership Application

Dear Doctor,
We look forward to your membership. By completing the application below, you are certifying that you are a physician and that you are opposed to mandatory vaccination laws. Upon the completion of your residency you will be able to join the members-only forum.

Honoree Information
 
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Physician Profile
Your name will remain confidential. We will not be making our membership public.
This information will be used to verify your license.
Physician friend? Newsletter? Networking?
Please let us know if you would like to volunteer as a contact person or mentor for physicians in your area.
 
 
Please list the name and phone number of a colleague we may contact.
Credit Card Information
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Billing Name and Address
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