Home Membership in SOIMA

All students at Nova Southeastern University College of Osteopathic Medicine are invited to be members of SOIMA.

ONLINE MEMBERSHIP APPLICATION
This application will be used to register you for both the NSU-COM chapter of SOIMA as well as establishing you as a student member of the American College of Osteopathic Internists (your application will be mailed to them).
Name:
AOA Number:
This is assigned by the AOA.  If you have not yet been assigned your number, please type "not yet assigned."
Mailing Address:
City:
State:
Zip:
Home Phone:
Social Security Number:
Date of Birth:
E-mail address:
Name of Spouse:
Expected Academic Degree Date:
Medical School:
Dues are $20 for M2s and $35 for M1s.  If you would like to pay online using a credit card, you may use Pay Pal at www.paypal.com.  Send your payment to: [email protected]. 

Don't forget to hit the SUBMIT button!
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