2026 Membership
UW Residents and Fellows: Submit the form below for free Wisconsin Medical Society membership thanks to the UWHC Graduate Medical Education Office!
Complimentary membership period has closed. Please visit
wismed.org
to become a member.
Name
*
First Name
Middle Name
Last Name
Suffix
UW Email
*
example@example.com
Preferred Contact Email
*
Confirmation Email
example@example.com
Preferred Phone
*
-
Area Code
Phone Number
Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Birthday
*
-
Month
-
Day
Year
Date
I am a...
*
Resident
Fellow
Residency or Fellowship Program
*
Residency or Fellowship Anticipated Completion Date
*
-
Month
-
Day
Year
Date
Have you ever been convicted of a felony crime related to medical practice within the last five years?
*
Yes
No
Has your license to practice medicine in any jurisdiction ever been limited, voluntarily surrendered, suspended or revoked?
*
Yes
No
Have you ever been the subject of any disciplinary action by any medical society, specialty society or hospital staff?
*
Yes
No
Have any settlements or judgments of malpractice claims been paid by you or on your behalf by another entity?
*
Yes
No
Have you ever had an application for membership in any medical or specialty society rejected?
*
Yes
No
Electronic Signature - Select "I agree" below to certify that all information provided above is complete and accurate to the best of your knowledge.
*
I agree
Submit
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