FSPM&R Membership Form

FSPM&R Membership Application

Florida Society of Physical Medicine and Rehabilitation
Who We Are
FSPMR is a Florida medical society, founded in 1962, representing the specialty of physical medicine and rehabilitation (PM&R), an organization exclusively serving the needs of PM&R physicians, also known as “physiatrists” (fizz ee at’ trist).

Core Value
The Florida Society of Physical Medicine and Rehabilitation serves its members by promoting our specialty and advocating public policy issues that relate to persons with disabling conditions. We will represent the interest of our members and their patients who have, or may develop temporary or permanent impairments or disabilities.

Our Mission
The Florida Society of Physical Medicine and Rehabilitation's mission is to promote and advance health and function through education and research in the field of Physical Medicine and Rehabilitation, in order to provide quality patient care and promote a person’s quality of life and improve functional outcomes.
PLEASE NOTE: You will need to allow pop-ups and/or redirects when using this form
Name*

First NameMiddle NameLast NameSuffix
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
COUNTY ( Florida Counties)
Practice Information Section
Practice Name
Practice Address

Street Address

Street Address Line 2

CityState

Zip Code
COUNTY ( Florida Counties)
Practice Phone Number
Please enter a valid phone number.
Practice Type:
Number of Physicians In Practice/ Group:
Number of PMR Physicians In Practice/ Group:
Practice Information: Practice Manager/ Admin's Contact Name Practice Manager/ Admin's Email address Area Code Phone Number
Personal and Professional Information
Florida Medical License Number
Fellow/Resident Section: Institution PGY
Choose an Option*

MDDONPOther
Membership Subscriptions

FSPM&R MembershipAllied Health ProfessionalResidentFellow/Medical Student
Membership Payment Section
Membership Plan Choices:

New Member with AUTO-PAY - $250New Member - paid yearly - $300Existing Member with AUTO-PAY - $250Existing Member -paid yearly - $300Allied Health Professional with AUTO-PAY - $125Allied Health Professional - paid yearly - $175
For Payment by Check:

Make payable to FSPMR

To Print this Applicaiton Form;
1. Select your Membership option,
2. Hit the PRINT button below
Remit with your printed Application Form to:

FSPM&R
9410 Bear Lake Road
Apopka, FL 32703

Questions?
email us at tjones@meyerresources.com
Click the SUBMIT & PAY button below and you will be directed to a payment page to securely enter your credit card information.

PLEASE NOTE: You will need to allow pop-ups and/or redirects when using this form
Should be Empty:

FSPM&R Membership Application

Practice Information Section

Personal and Professional Information

Membership Payment Section