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.

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.

  • Personal Information

  • 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.
    • A portrait color photo.
    • Jpg or tif format, 300 dpi resolution
    Type of primary address
  • Primary Practice

  • Secondary Practice

  • Insurance

  • Medical Licensing

  • NumberDate Issued
  • StateNumberDate Issued 
  • Specialty

  • Education and Training

  • NameStateYear Graduated 
  • StateBeganEnded 
  • StateBeganEnded 
  • StateBeganEndedCourse of Study 

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