KCSO&O General Membership Renewal

KCSO&O General Membership Renewal 2022
This form allows registration for single or group renewal of membership to the Kansas City Society of Opthalmology and Otolaryngology for the 2021-22 calendar year. To review full membership benefits, please visit the KCSO&O membership webpage here. Membership to the Society allows access to the 2022 Annual Conference.

The membership fees are as follows:

$250 KCSO&O Membership per individual (2022)
$50 late fee added for renewal received after 12/31/2021.
Free for Life Time Members. Please fill out the entire form and select "Life Time Member" as a payment option.
Are you seeking Single or Group Membership?

SingleGroup
Were you are a member of KCSO&O in 2021?

YesNo
If you are not an active, paying member of KCSO&O and would like to apply for membership in the society, follow this link: KCSO&O New Member Application Form.

Group Membership
Office or Group Name*
Admin Contact Info*

First NameLast Name
Admin Email*
example@example.com
Admin Phone Number*

Area CodePhone Number
Please Note: New Members MUST fill out a separate form. This is only for renewals.

Please fill out the information for each physician seeking renewal*

Member Information
Name*

First NameLast Name
Email*
example@example.com
Office Name*
Has any of your information changed from last year? (i.e. new office, different email, etc.)*

YesNo
If so, please tell us what has changed:*
Please list your administrator if you would like him or her to be on our email distribution list:
Admin Name:

First NameLast Name
Admin Email
example@example.com
The Hal Foster Award was developed in 1991 and is presented to members of the Kansas City Society of Ophthalmology and Otolaryngology who have demonstrated exemplary dedication and service to the Society and the local medical community. Please enter your nomination below.

Payment Information
Preferred Payment Information*

Credit Card (PayPal is our processor, no account is needed)Invoice or CheckLife Time Member (No Payment Necessary)
Credit Card Payment
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KCSO&O 2022 Renewal $300.00

Quantity
Item subtotal:$0.00

Total $0.00
After clicking submit, a registration notification will be sent to the email provided. Please print and remit payment per instructions in the email.

Check Payments can be sent to:

INMED CE

2340 E. Meyer Blvd.

Building 1, Suite 338

Kansas City, MO 64132
Should be Empty:

KCSO&O General Membership Renewal 2022