Membership Tool

Name*

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Specialty

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Do you currently have an unrestricted license to practice medicine?*

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Has your license ever been suspended or revoked?*

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Have you ever been convicted of a felony offense?*

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Total

$0.00

I would like to pay by:*

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To pay by check, please mail to the following address and indicate clearly on the check what it is for:

Illinois Osteopathic Medical Society
4200 Conestoga Dr #150
Springfield, IL 62711

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