Contact the Association for Medical Ethics with any questions, or to find out more about our organization.

To join the Association for Medical Ethics, you may be either a physician, physical therapist, occupational therapist, nurse, physician’s assistant, medical technician, or professional in the health care field.  Please fill out the following membership application form.

I, Name: *  Last Name: * 
Title (MD, PhD, PT, OT, RN, PA, etc): *

I do agree that I meet the following requirements and will follow the Association for Medical Ethics by-laws listed below:

1. I am a physician, in good standing with the medical board of my specialty as recognized by the American Board of Medical Specialties.
Please fill in the medical board of which you are a diplomate

2. I am a registered physical or occupational therapist, nurse, physician’s assistant, a physician in training, or other professional in the health care field and am  interested in supporting the principles of the Association.

3. If I collect royalties for any patent I own, then it is for a patent that I have genuinely invented and was not “assigned” as a disguised compensation for using or advocating use of a medical product.

4. I do not accept compensation in any form for merely using a medical product as this is both illegal, unethical, and a kickback.

5. I do not accept gifts from any medical manufacturer.

7. I do not own any portion of a distributorship for any products used in my medical practice or training.

8. I agree to expulsion from the Assocation for Medical Ethics for violation of membership requirements.

DECLARATION: I declare under penalty of perjury that my membership information is true and correct to the best of my knowledge and belief. As to that information, I declare under penalty of perjury that the information accurately describes as well, any related information provided to me, and that I believe it to be true.

Dated this day of 2010, in the County of , State of .