Student Application - Kansas Medical Society

Student Membership Application

To apply for KMS membership, please complete the form below.

After we review your application, our staff will follow-up with your dues statement. Your membership will become active once all membership-related queries are fulfilled and payment is received. (Information on membership dues may be found here.)

If you practice in Sedgwick county, please contact the Medical Society of Sedgwick County for membership information. They can be reached at 316.683.7557

Personal Information

First Name *

Middle Initial *

Last Name *

Suffix *

Gender *

Male

Female

Degree *

Date of Birth (mm/dd/yy) *

Email *

Medical School *

Graduation Year *

Home Address

Mailing Address *

City, State Zip *

Phone *

Anti-Spam

Anti-spam Captcha *

2 - 5 =

Name

Student Membership Application

Personal Information

Home Address

Anti-Spam

In this section:

Pay Dues Online