Colorado Medical Society and Boulder County Medical Society application for membership

Thank you for your interest in the Colorado Medical Society and the Boulder County Medical Society. To join, please complete the application below and submit your membership payment by credit card or mailed check.

If you have any questions or need assistance, don’t hesitate to contact us at membership@cms.org — we’re happy to help.

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Name *

First

Middle

Last

Medical DegreeMDDO

Email *

Phone

Name Total Birthdate

Birthdate

Colorado Medical License #

Practice specialty

NPI *

Gender IdentityPrefer not to sayMaleFemaleNon-binary

Home Address

Address Line 1

Address Line 2

City

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Zip Code

Business Address

Address Line 1

Address Line 2

City

— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Liability insurer

Select your membership type: *

• Active Currently practicing full-time. – $890.00
• Active I A physician currently in their first year out of any training programs (internship, residency, fellowship, etc.) – $365.00
• Active II A physician in their second year outside of any training programs. – $630.00
• Part-time Currently practicing 20 hours a week or less on average. – $480.00
• Military A physician in active military service. – $300.00
• Retired No longer practicing with the exception of volunteer/unpaid work. – $200.00
• Graduate Currently in a training program such as an internship or residency. – $28.00

Processing fee

Total

$0.00

Includes a 3% processing fee

Pay by check

• Pay by check

You can mail your dues to:

Colorado Medical Society
PO Box 17550
Denver, CO 80230

Please be sure to include the name of the member you are paying with along with your remittance.

Pay and join now *

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