Learn about the benefits of becoming a member of The Medical Society of the County of Queens.

Apply For Membership - Fill out this form
Step 1 :: Tell us about yourself
First name*
Last name*
Practice Name
Degree MD/DO
Date of Birth*	(* please use format MM/DD/YYYY)
Gender*	Male Female
Primary Specialty*
Secondary Specialty
License#
Board Certifications
Board Certification Dates
NPI#
Foreign Languages spoken by Staff
Foreign Languages spoken by Doctor
Hospital Affiliation
Worker's Comp Rating
Office Manager's Name
Office Manager's Email
Step 2 :: Member sign in :: this will be your login to the members area
Email*
Password*
Step 3 :: Contact details
Phone*
Home Phone
Mobile
Fax
Address 1*
Address 2
City*
State*
Zip*
Website	* PLEASE NOTE - USE THIS FORMAT * http://www.webeval.com
Step 4 :: Click the button below to submit your application
Comments
Notes

County and State membership are unified. Physicians may join the county society where they practice or reside.

Medical Society of the State of New York
Medical Society of the County of Queens

• Established Physicians:$720 first year, $710 thereafter
• 1st - 2nd Year Practice: $480
• Part-time (fewer than 20 hrs/week): $480
• Resident / Fellow: $45

In addition, if you are not already an AMA member, we urge you to support the association that addresses national issues such as Medicare and Tort Reform. AMA Dues:

• Regular: $420
• 2nd Year Practice: $315
• 1st Year Practice: $210

Please note: payment by check or online will follow on the next page, after your application is submitted.