Student New Member Application

Welcome! The Texas Medical Association is an organization of physician and medical student members working to promote excellence and professionalism in medicine. When you join TMA you also become a member of your county medical society.

As a medical student, you are eligible for FREE membership in the Texas Medical Association and your county medical society.

Name

First name

Middle name

Last name

Maiden name

Other legal names

Home Address

Address 1

Address 2

City

State

Zip

Phone

Identifying Information

Data of birth

Gender

Ethnicity - optional (aggregate demographic purposes only)

Marital Information

Marital status

Spouse's name

Is spouse also a student/physician?

YesNo

Medical School

Medical school

Degree sought

Estimated graduation date

Membership Authorization

I hereby apply for membership in the County Medical Society and Texas Medical Association and, if accepted, agree to abide by and be subject to terms and conditions of the Constitution and Bylaws of the Society and of the TMA and the Principles of Medical Ethics of the American Medical Association. In order to process my application for membership, I grant permission and consent for you to obtain from any appropriate source all relevant information concerning my credentials and qualifications.

I understand that if my application for membership is denied by the Board of Censors, I have a right to appeal the denial to the County Medical Society pursuant to the Hearings Procedure Manual. I also understand that if my application for membership is denied, based on professional competence or conduct, the County Medical Society must report such a professional review action to the National Practitioner Data Bank through the Texas Medical Board within 15 days of the date that all due process rights have been exhausted.

I also agree that biographical information will be disseminated in accordance with the policy and procedures established by the TMA Board of Trustees unless otherwise directed by me.

Note: Membership becomes effective when application has been approved by your county medical society board of censors and dues have been paid to the Association.

American Medical Association

Navigate medical school and grow professionally with support from AMA! Join AMA today and receive a four-year student membership for $68 and a free gift of your choosing. Visit www.ama-assn.org/go/joinstudent to apply.