Membership Applications and Forms

Membership Form for MD's and DO's 
Welcome to the MecklenburgCounty Medical Society  

For an application form that you can print out from your computer, just CLICK HERE, or click the link below. Then complete both pages of the form, sign, date and return it to the Medical Society, 1112 Harding Place #200, Charlotte, NC28204, with your dues payment and a copy of your CV. You may fax the application and CV to 376-3173 but please call the Society's office to provide dues payment information. The Medical Society will verify licensing and obtain a physician profile from the AMA. 

Your application will be reviewed by the MCMS Secretary and be recommended to the Board of Directors for approval. You will be notified after the Board of Directors meeting of your status. Your application will be sent to the North Carolina Medical Society. They will bill you for membership in the state Society and AMA, if you choose to join these associations. The MecklenburgCounty Medical Society encourages you to support and join all levels of membership.

MEMBER SERVICES WILL COMMENCE UPON BOARD APPROVAL AND RECEIPT OF YOUR DUES

Payments to the MecklenburgCounty Medical Society are not deductible as Charitable Contributions for Federal Income Tax purposes. However, they may be deductible under other provisions of the Internal Revenue Code.

MCMS Physician's (MD or DO) Application Form

Physician Assistant (PA) Membership Information and Application