Instructions: This is an electronic version of the ISMA member application. Please type your information into the fields provided. When you’ve completed the online member application process, this application will be automatically emailed back to the ISMA for processing. If you wish to fill out the application by hand, you may print it and mail the completed form back to the address listed at the end of the application. Vigo County and Fort Wayne physicians must print and fill out additional addendums for those counties. The addendum must be mailed in and will be included in your confirmation email.
If your application will be completed entirely online, then dues payment (AMEX, MasterCard or VISA credit card) is required to complete the transaction.
*Denotes Required Field
Renewal of your county, state and district memberships will be due by January 15th of each calendar year. An optional contribution to the Indiana Medical History Museum may also be included.
If dues payment is not included with this application, the Indiana State Medical Association (ISMA) will forward a dues invoice. Medical Association dues (except for specific governmental affairs expenses) may be deductible as professional or business expense to the extent allowable by law. Dues and other contributions to the ISMA and any county or district society are not deductible as charitable contributions for federal income tax purposes.