Your Involvement As A Member Is Critical To Our Success and Yours RI Society of Osteopathic Physicians and SurgeonsMembership Application The MOS is dedicated to meeting the needs of the Massachusetts osteopathic physician and strengthening the osteopathic community in our state. Demographic InformationName *AOA MemberYesNoIf yes, AOA ID:Preferred Email Address: *Alternative Email Address:Degree: *DOMDOtherOther degree:Office Address:Institution NameStreet AddressCityState/ProvinceZIP / Postal CodeHome Address:Street AddressCityState/ProvinceZIP / Postal CodeMobile Phone *Other PhonePractice InformationSpecialty *Are you accepting new patients for OMT? *YesNoAre you accepting new patients for primary care? *YesNoState(s) of License:If Licensed in RI, enter license #:Board Eligible/Cert. *YesNoBoards:CertificationI certify the above information is accurate and that I am in compliance with the regulations of the State Board of Medical Licensure.Membership PaymentMembership type *Active ($225)Military ($175)Retired ($175)Student ($25)Resident ($35)Allied ($50)Price JoinPlease do not fill in this field.