Membership Application Form


To apply for membership to the Indian Doctors Association you can either fill out the secure form below, or you can print out the application (in Adobe PDF format) and mail it to us. Click here to get the Adobe PDF Reader if you do not currently have it installed on your computer.

First Name * :
Last Name * :
Spouse Name * :
SLast Name * :
Home Address * :
City * :
State & Zip:   
Tel(Home) * : - -
Cell :
Fax :
Year Of Graduation
Fee * :
Specialty * :

Spouse Specialty :
(Only if registering for both)
Office Address :
Office City :
Office State & Zip:   
Tel (Office) : - -
Pager : - -
E-mail * :
Medical School:
   

*The information provided is confidential and only for IDA related activities

Would you like to be listed on the Web-site/IDA directory? : Yes No
(Only the specialty and office information will be listed on the Website/IDA Directory)
Would you like to have a web page of your practice linked to the IDA website [ $100 / yr ]? : Yes No
If yes, Website Address:
Would you like to contribute towards a Medical Student Scholarship fund?: Yes No If yes,   $
Would you like to contribute towards the IDC Charity Clinic? YesNo If yes,   $
Would you like to volunteer once or twice a year at the IDC Charity Clinic?: Yes No
Are you a Life Member of IDA? : Yes No
All dues are tax deductible
* Required information.
** Paid Member spouse pays 50% of dues
Only the Specialty and office information will be listed on the web site and IDA directory unless otherwise requested.
image gallery
 picture of a pumpkin picture of a pumpkin picture of a pumpkin picture of a pumpkin picture of a pumpkin picture of a pumpkin picture of a pumpkin picture of a pumpkin picture of a pumpkin picture of a pumpkin picture of a pumpkin picture of a pumpkin