CMS Join Application

Thank you for your interest in the Colorado Medical Society. CMS has unified membership with our local component societies; however, you live or work in an area without an active local medical society and have no additional component dues. All CMS physicians have representation on the CMS Board of Directors through your District, and CMS is committed to supporting physicians without an active local 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

Birthdate

Colorado Medical License #

You do not need to include the ‘DR’ or leading zeroes (‘0’)

NPI # *

Gender IdentityPrefer not to sayFemaleMaleNon-binary

Practice specialty

specialty Birthdate fee

Liability insurer

Home Address

Address Line 1

Address Line 2

City

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

Zip Code

Business Address *

Address Line 1

Address Line 2

City

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

Zip Code

Select your membership type: *

• Active Currently practicing full-time. – $615.00
• Active I A physician currently in their first year out of any training programs (internship, residency, fellowship, etc.) – $215.00
• Active II A physician in their second year outside of any training programs. – $430.00
• Part-time Currently practicing 20 hours a week or less on average. – $330.00
• Military A physician in active military service. – $215.00
• Retired No longer practicing with the exception of volunteer/unpaid work. – $150.00
• Graduate Currently in a training program such as an internship or residency. – $0.00
• Student Currently in an MD/DO education program in Colorado. – $0.00

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.

Processing fee

Total

$0.00

Includes 3% processing fee

Pay and join now *

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Security Code

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