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Application
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Nassau County Medical Society |
Membership Dues & Information
Membership dues for the Nassau County Medical Society (NCMS) are combined with dues for the Medical Society of the State of New York (MSSNY). Optionally, your application can also include membership with the American Medical Association (AMA).
2005 Dues Paying Membership Fees
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All doctors must have a legal residence or principal office in Nassau County. The membership application must be signed by two (2) active members of the Nassau County Medical Society. The following information should also be included:
A small recent photograph of yourself or a copy of your driver’s license.
Photocopy of current registration of New York State Medical License.
Proof of Board Certification - if not certified, proof of Board eligibility. (Copy of residency certificate of completion or a letter from a hospital administrator confirming completion of approved residency or a letter from Specialty Board indicating that you have been admitted to take an examination to be given on a specific date).
Interns & Residents - Membership application must be signed by two sponsors who are active members of the Nassau County Medical Society. Please enclose a small current photograph of yourself or a copy of your driver’s license. Also include a letter from your chief of service attesting to your bonafide internship and residency in the hospital from:______ to:_____.
Medical liability insurance is available through the State Medical Society’s MEDICAL LIABILITY MUTUAL INSURANCE COMPANY. For information on obtaining coverage, call 212-576-9800 or 516-794-7200, or write to the MLMIC at 2 Park Avenue, New York, NY 10016. This is a doctor-owned, doctor-run insurance company.
Please answer all questions fully and mail the completed application together with your check made payable to the NASSAU COUNTY MEDICAL SOCIETY to the attention of:
Mrs. Adrienne Morvillo
Nassau County Medical Society
1200 Stewart Avenue
Garden City, NY 11530
How to Obtain a Membership Application
Membership Applications are available from the Nassau County Medical Society by contacting Mrs. Adrienne Morvillo at (516) 832-2300 ext. 20. We would be pleased to mail or fax you an application.
The Membership Application can also be downloaded to your computer then viewed and printed as an Adobe Acrobat® file. Acrobat encapsulates all of the fonts and formatting functions that where used when creating a document enabling it to be sent quickly over the internet as a Portable Document File (PDF). Once the PDF file has been received on your computer you can use the Acrobat Reader program to view and print the forms on your printer.
If you already have a copy of Adobe Acrobat Reader, then you may download a form immediately by clicking on the name of the form above. The PDF file sizes are relatively small and will take only a few minutes to download, depending upon your modem and connection speed. When the file transfer is complete just click on the filename to launch Acrobat Reader and open the form.
If you do not have a copy of Acrobat Reader you can get one for free by clicking on the icon 'Get Acrobat® Reader'. This will take you to Adobe's website and enable you to download the Acrobat program to your computer.
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