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 e-mailed 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 e-mail.
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
If submitting application by mail, within 30 days of receipt of the approved application from your county medical society, the ISMA will forward a dues statement. Thereafter, renewal of your county, state, and district memberships will be due by January 15th of each calendar year.
Optional contributions to the Indiana Medical Political Action Committee (IMPAC) and the Indiana Medical History Museum may also be included with your ISMA, district and county dues.
In most cases, medical association dues (except for specific governmental affairs expenses) may be deductible as professional or business expenses to the extent allowable by law. Dues and other contributions to the Indiana State Medical Association, any county society and district society, and IMPAC are not deductible as charitable contributions for federal income tax purposes. In addition, no portion of any dues paid to IMPAC can be deducted as a business expense on your federal income tax return.