KCMS Membership Form

Membership Form

Renewing Members and Applicants
Name

First NameLast Name
Credentials
Email
example@example.com
Email (Second or Personal email)
example@example.com
Mobile Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Membership Renewal Categories

Physician Membership: $120 annually

Partner Hosptial Membership: Paid for by your Hospital. 2026 Partner Hospitals include North Kansas City Hospital (NKC Health) and University Health - Kansas City. Please still complete this annual form to update your information.

Medical Students & Residents: Free

Lifetime Retired Physician Membership: $870 one time fee paid by check
Your Payment Method
If you are paying by check, please submit payment to:

KCMS

C/O Micah Flint

210 SW Market Street, Ste. 227

Lee's Summit, MO 64063

Specialty or Primary
Subspecialty
Employer Name (Medical Students or Residents, please provide training center name)
Are you a MSMA Member?
Are you a KMS Member?
Are you currently an active member of the medical staff at North Kansas City Hospital or University Health–Kansas City?

Physician Membership Renewal (if you are not submitting a Physician Membership Renewal, please skip the payment portion and click Submit)

Physician Membership Renewal

$120.00 for each year

Medical Staff at NKC Health or UH-KC

Partner hospital

Free for each year

Medical Student & Residents

Free for each year

Email

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty: