• By completing and submitting this application, I attest that I hereby agree to uphold the duties, responsibilities and standards set forth in the North Carolina Osteopathic Medical Association's Code of Ethics and Bylaws. I also agree to pay the indicated amount on the NCOMA membership application.

  • Membership Application

  • Contact Information

  • Licensing Information

  • Has your license ever been suspended, revoked, surrendered, or otherwise encumbered by any regulatory boards or are you currently under investigation by any regulatory board?
  • Have you ever been convicted of a felony offense or court martial?
  • In order for us to make the most effective use of our funds earmarked for marketing, please tell us how you learned about our association. Select all that apply.
  • Fee and Payment Information

  • The pro-rated fee schedule is as follows: From July - September, one-half of the fee is owed. From October - December, one fourth of the fee is owed.
  • Please enter your name in the space above to indicate that you have read the following. I understand that my approval for initial membership is contingent upon my answers to the questions regarding the status of my medical license and past convictions and payment of annual membership fees. If upon review of this information, it is the determination of the Executive Committee of the NCOMA Board of Trustees that my application cannot be approved, the most recent payment of membership fees will be returned minus a $25 processing fee. Thank you for your interest in becoming a member of NCOMA. We look forward to having you as a member of our association.
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Online Payment

You may now pay your dues easily and securely online.  When you submit the electronic membership application, the on-line payment option will appear.  If you  completed a paper application and wish to pay online, select the Pay Now option below.