KCSO&O Membership Registration Form

KCSO&O Membership Registration Form
Thank you for membership to The Kansas City Society of Ophthalmology and Otolaryngology.

The 2026-2027 membership fees are as follows:

General Physician Membership $250 (Ophthalmology or Otolaryngology - Includes attendance to the Annual Conference)

General Physician Membership + Journal Club $525 (Ophthalmology Only - Includes 3 Journal Clubs & Annual Conference)

Resident Membership $100 (Ophthalmology or Otolaryngology - Includes attendance to the Annual Conference)

Resident Membership + Journal Club $175 (Ophthalmology Only - Includes 3 Journal Clubs & Annual Conference)

Lifetime Membership - Contact INMED at cme@inmed.us for more information

To review full membership benefits please visit the KCSO&O's membership webpage here: https://www.kansascitysoo.org/
I am a(n)
Practicing Physician

Personal Information
Name

First NameLast NameCredentials
Email
Please place email you are most likely to check.
Mobile Phone Number

Area CodePhone Number
Office Name (If Self Employed or Retired Please list so)
Field:
Admin Information
Would you like an Admin to be listed for communication purposes?
Admin Name

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

Area CodePhone Number

Educational Information and Board Certification
Do you have an Updated CV?
Please Attach CV

Browse Files

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Other

Group Information
Office Name
Admin Name

First NameLast Name
Admin Email
example@example.com
How many individuals are you registering for Ophthalmology?
How many individuals are you registering for Otolaryngology?
Members

Professional Ethics Acknowledgement
KCSO&O Members agree to the following:
ELECTRONIC SIGNATURE By entering your name, you are electronically signing this agreement and authorization of the specified document above.

First NameLast Name
Todays Date:

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Payment
Ophthalmology Registrations:
Otolaryngology Registrations:

Membership Selection

Rows	# of Members	Subtotal
Ophthalmology General Physician Membership ($250)
Ophthalmology Only General Physician Membership + Journal Club ($525)
Otolaryngology General Physician Membership ($250)
Ophthalmology Resident Membership ($100)
Ophthalmology Only Resident Membership + Journal Club ($175)
Otolaryngology Resident Membership ($100)

Total
For Checks
Credit Card Payment Amount

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Please select your payment type:
Please make out the check to INMED CME.
Check Payments can be sent to:

INMED CME Attn: KCSO&O
2340 E. Meyer Blvd.
Building 1, Suite 338
Kansas City, MO 64132
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