KOMA | Kentucky Osteopathic Medical Association


KOMA Membership Renwal 2013 Enter your information below. All fields marked with an asterisk (*) are required.
Contact Information
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Middle Name/Initial
Last Name*	A value is required.
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Company/Institution*	A value is required.
Address*	A value is required.

City*	A value is required.
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County in KY*	A value is required.
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Fax
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Practice Type*	Please select a valid item.Please select an item.
I am willing to be a contact for shadowing.	Please select an item.
Membership Fees+
Please select the appropriate Membership Level:
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+A percentage of dues payments are deductible by members as an ordinary and necessary business expense. The organization estimates 2% of your annual membership dues is spent on lobbying expense and therefore nondeductible as a business expense. Please consult your tax professional for further information.
Contribution	Please consider a contribution to the the Student Presentation Fund. Just $50 covers one Student.
Payment
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CVV*	A value is required.What's This?

Kentucky Osteopathic Medical Association
2424 American Lane
Madison, WI 53704

Phone: 608.441.1060
Fax: 608.443.2474
info@koma.org

Kentucky Osteopathic Medical association