Application & Processing Fee
To be considered, physician applicants must be board-certified within their practicing specialty and faculty members of major medical societies.
Activities representing faculty-level membership may include board membership on a medical society, and/or having a recent history of journalistic publications or podium presentations.
All applications are subject to a stringent vetting and approval process reviewed by a group of WPO peer physician members.
A $200 application fee is required. Upon submission, your credit card will be charged.
Once approved, your credit card will automatically be charged the cost of membership. Your application fee will be credit against the cost of membership.
National Provider ID Number
Please list any medical societies you are a member of
Please list any medical societies in which you sit on the board (or equivalent body)
If so, please list the titles of at least your last three presentations and dates
Please list your three most recent publications (if any)
Are you a consultant to industry?
If so, please disclose the companies you have been a consultant for:
Credit Card Number
The 16 digits on the front of your credit card
The date your credit card expires. You will find it on the front of your card.
Security code (or "CVC" or "CVV")
The last 3 digits displayed on the back of your credit card
Your zip/postal code as it appears on your credit card statement
By initialing below, I authorize World Physicians Organization, LLC to store and charge this card for future purchases as agreed until I cancel this authorization. I understand I will be charged $200 now, and if my application is approved, will be immediately charged an Annual Membership Fee. I understand that my Annual Membership term begins now and lasts one (1) year, or until December 31, 2018, whichever is later. I also understand that my credit card will be automatically charged on my next renewal date unless I provide a cancellation request at least FIVE (5) days prior to my next renewal date.
By checking this box, I acknowledge that I have clicked on the Membership Terms button below and have read and understand such Terms.
Thank you for submitting your application! Your credit card will be securely processed.