LOS Membership Application

LOS Membership Application

2025 New Members
About You
Membership Type*
Full Name*

First NameMiddle NameLast NameSuffix
Your Degree/Credentials (for example: MD, MBBS, DO, PhD, RN, APRN, RD etc.)*
Practice/Program Name*
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Email*
example@example.com
Cell Number*
Please enter a valid phone number.
I am a *
Your Profession
Are you already treating obesity?*
Are you ABOM certified?*
What is your medical field?*
Other medical field
Profession*
Other*
Are you a member of ASMBS?*
Join a Committee

Get Involved with LOS!
Check which committee you are interested in joining.

AdvocacyAPPBehavioral HealthCommunicationsMembership CommitteeNutritionPedsEducationFinance
2025 LOS Dues

Physician/Surgeon Membership

$100.00

Non-Physician Membership

$50.00

Industry Membership

$200.00

Total

$0.00

About You