Online Membership Application

When your application is complete, click the SUBMIT button at the bottom of the page to send your application to us.

You will receive automatic email notifications updating the status of your application.

A printable application form is also available for those who wish to apply by mail.

Thank you for applying to King County Medical Society! We look forward to serving you.

"*" indicates required fields

Personal Information

Birth Date*
Accepted file types: jpg, png, tif, tiff, Max. file size: 500 MB.
A recent photograph is required with your application. You can upload one here, or send one by email or mail later.
Specifications:
• A portrait color photo.
• Jpg or tif format, 300 dpi resolution
Primary Mailing Address*
The above address is your:*
Type of primary address

Primary Practice

Secondary Practice

Insurance

Insurance Accepted:*

Medical Licensing

Washington State Medical License*
Number
Date Issued
Other State Licenses
State
Number
Date Issued
 

Specialty

Practicing in King County as of*
Is this your first year of practice?*

Education and Training

Medical School*
Name
State
Year Graduated
 
Residency Institution*
State
Began
Ended
 
Specialty
State
Began
Ended
 
Additional Training
State
Began
Ended
Course of Study
 

 

When you submit this form, you will be taken to the Membership Payment page, where you can pay for your membership.