Apply for membership

Download the form below or fill out the application online.  Click here to pay dues online.

Application for Membership
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  4. (valid email required)
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  6. Medical Training and Education
  7. Residency/Fellowship - Hospital/Institutions
  8. Medical Licensure
  9. Has your license to practice in any jurisdiction ever been denied, restricted, limited, suspended or revoked; have you ever been reprimanded by a licensing agency; or have you ever surrendered your license?
  10. I hereby certify that I am a legally registered physician, residing or practicing in Stark County in the state of Ohio and that I have not been convicted of a felony. If accepted as a member, I agree to abide by the Constitution and Bylaws of the SCMS and the OSMA, and the Principles of Medical Ethics of the American Medical Association.
  11. Please answer the question below to prevent spam

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