Membership Application

For Physicians (MD’s and DO’s)
For Physician Assistants (PA’s) 

To print an application form, click on a link above.  Complete all pages of the application, sign, date and return to the Mecklenburg County Medical Society, 1112 Harding Place, Suite 200, Charlotte, NC  28204, with your dues payment and a copy of your CV.  Or you can fax the application and CV to 704-376-3173 and call the office at 704-376-3688 to provide payment information.  We will verify licensing and obtain a physician profile from the AMA.

Your application will be reviewed by the MCMS Secretary and recommended to the Board of Directors for approval.  You will be notified after the Board of Directors meeting of your status.

Member services will begin upon Board approval of your application and receipt of your dues.

Dues   PAY DUES NOW
     
Application approved January through June:
  Physician (MD or DO) $300
  First year after residency (MD or DO)   $150
  Physician Assistant $105 (MCMS membership only) or, 
$90 (Dual membership – MCMS and MAPA) MAPA – Metrolina Association of Physician Assistants
     
Application approved July through December:
  Physician (MD or DO) $150
  First year after residency (MD or DO) $74
  Physician Assistant $53 (MCMS membership only) or,
$45 (Dual membership – MCMS and MAPA) MAPA – Metrolina Association of Physician Assistants

Free Membership for Residents/Fellows

Free membership in North Carolina – Your County Medical Society (MCMS) and your State Medical Society (NCMS) offer dues-exempt membership to residents and fellows as long as they enroll as part of an accredited residency training program.

Free Membership to Emeritus (fully retired) Members, 70 years of age and member of the Medical Society at least 10 years.
Emeritus members of the MCMS are exempt from paying dues.

Half Dues for Emeritus-Early Retired (retired before the age of 70)         $150

Payments to the Mecklenburg County Medical Society for dues are not deductible as charitable contributions for federal income tax purposes.  However, they may be deductible under other provisions of the Internal Revenue Code.