Membership Application

$2,000

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 $2,000 membership fee is required (which includes a $200 application fee). If you are not approved for membership, your original method of payment will be refunded $1,800.

Name *
Name
Practice Address *
Practice Address
Cell Phone *
Cell Phone
Are you a consultant to industry? *
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.
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 $2,000 now (which includes a $200 non-refundable application fee). If I am not approved for membership, I will be refunded $1,800 to my original method of payment. 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.
MEMBERSHIP TERMS *