Membership Application

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There are three different categories of membership:
1. Individual     $25
2. Corporate    $25
3. Non-participatory   $25
As we are a not-for-profit: we always welcome donations
Name
Membership Category
Email
Organization
Phone
Submit
We are sorry for any inconvenience but we are not able to accept membership payment online currently.  You may submit your application online, and then mail your payment to:
COSS 
c/o Fort Wayne Medical Society
​709 Clay St. Suite 101
Fort Wayne, IN  46802