IOMA Membership Application 2026 - Individual Registration

Thank you for submitting an application for IOMA membership! IOMA staff will be in touch after reviewing your application.

If you have any questions, staff can be reached at:

Iowa Osteopathic Medical Association
1415 28th Street, Suite 400
West Des Moines, IA 50266

Phone (515) 282-8192 * Fax (515) 282-9117

To pay by check, download this form to fill out and mail with your check.

First Name *

Last Name *

Degree *

Email *

Degree *

Gender *

Date of Birth *

Spouse's Name

Company/Clinic/Organization *

AOA Number *

Office/Billing Contact Name

Office/Billing Contact Email

Address *

City *

State *

Zip Code *

Country *

Phone *

Fax

Cell Phone *

I opt in to receiving texts from IOMA and understand that SMS/data rates may apply. *

Yes

Has your license to practice medicine ever been denied, suspended, or revoked by any government agency? *

Primary Specialty *

Board Certified *

Are you a fellow? *

Date Certified *

Name of Board *

Second Specialty

Board Certified

Are you a fellow?

Date Certified

Name of Board

Osteopathic/Medical College graduated from

Internship

Graduation Year *

Year Completed

Residency *

Years in Practice *

Memberships in Other Professional Associations

AOA

ACOFP

AMA

IMS

PCMS

OTHER

Other Association Membership

I would like my membership to auto renew for 3 years *

Yes

Contributions, gifts, or dues paid to IOMA are not deductible as charitable contributions for federal income tax purposes. However, dues and other payments may be deductible by members as a business expense. Please consult your tax advisor.

How did you hear about IOMA? *

Emails

Friend

Facebook

Instagram

IOMA Website

Hardcopy Mailing

Colleague/Clinic

Other

By submitting this online form, I understand and agree that IOMA will have my contact details for the purpose of processing my information and ensuring full participation.

Other *

Enter the Name of the Person Who Referred You

Payment Information

IOMA has transitioned to our own secure payment gateway. As a result of this change, a 3.25% convenience fee will apply to all credit card payments to help IOMA cover the cost of accepting credit cards. Please let us know if you have any questions. We appreciate your continued support of IOMA.

If you'd like to avoid the credit card processing fee, please mail a check to IOMA at 1415 28th Street, Suite 400, West Des Moines, IA 50266.

Amount

Payment Processing Fee

Total Due

Payment Method

Secure Payment Processing (credit card)

Captcha*

Please enter the text you see in the image in the text box for captcha validation