IOMA Membership Dues Renewal 2023-2024 - Individual Registration

Please enter information in the form below to process registration for event IOMA Membership Dues Renewal 2023-2024.

First Name *

Last Name *

Degree *

AOA Number

Clinic/Office Name *

Office Billing Contact Name

Office Billing Contact Email

Address *

City *

State *

Zip Code *

Phone *

Email *

Fax

Membership Rates *

First Year in Practice $150.00

Second Year in Practice $250.00

Third Year in Practice $375.00

Four or More Years in Practice $495.00

Honorary Member/Retired $247.50

Out of State Membership $120.00

Osteopathic Student $0

Resident/Fellow $0

You are automatically opted into a donation of $75 for supporting furthering support of Osteopaths in Iowa. You may change this to any amount you choose.

Voluntary Contribution

Contributions, gifts, or dues paid to IOMA are not deductible as charitable contributions for federal income tax purposes. However, dues and other payments may be deductible by members as a business expense. Please consult your tax advisor.

By submitting this online form, I understand and agree that IOMA will have my contact details for the purpose of processing my information and ensuring full participation.

Payment Information

IOMA has transitioned to our own secure payment gateway. As a result of this change, a 3.25% convenience fee will apply to all credit card payments to help IOMA cover the cost of accepting credit cards. Please let us know if you have any questions. We appreciate your continued support of IOMA.

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Secure Payment Processing

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Card Holder Name*

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IOMA Iowa Osteopathic Medical Association

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