Please select appropriate membership category. Return to Membership Category explanation.
ACTIVE PREVIOUS MEMBER ($399.00)ACTIVE NEW/FIRST YEAR MEMBER ($199.00)ACTIVE PART TIME MEMBER ($199.00)NON RESIDENT ($195.00)ASSOCIATE ($195.00)ASSOCIATE (AMC MEMBER SUPERVISED) ($78.00)AFFILIATE ($75.00)HEALTH CARE ADMINISTRATOR ($150.00)
Please complete items applicable to your membership category.
All Membership Categories
First Name Middle Last Name MD/DO/Other
Date of Birth MALEFEMALE Medical School Graduation Date
City State Zip Code
Home/Cell Phone Preferred Email Address
Active/Non-Resident/Associate/Health Care Administrator Members, please complete the following:
Practice/Group Name Web Address
Primary Office Address
Primary Office Telephone Office Fax
Primary Specialty Board Certification
Secondary Specialty Board Certification
Preferred Mailing/Billing Location: OFFICEHOME
If accepted as a member, I agree to abide by the Academy of Medicine of Cincinnati Articles of Incorporation and Code of Regulations. I understand and agree that by providing my address, email(s), telephone numbers(s), and fax number(s), I consent to receive communications sent by or on behalf of the Academy of Medicine of Cincinnati via regular mail, email, telephone, or fax.
By checking I agree to the terms and conditions above.
You will be directed to a secure payment page.
Enter the code shown above:
(Note: If you cannot read the numbers in the above
image, Click the Image to generate a new one.)