FMA Membership Application

STEP 1: Do you have a Florida Medical License or FMA ID? (If you can’t complete Step 1, please move on to Step 2.) 

  • If NO, move on to Step 2
  • If YES, you may already be in our system. Enter one of the following to see.

STEP 1:
FL Medical License
OR FMA ID #
STEP 2:
New Member Application
Personal Information
Prefix
First Name  
Middle Name
Last Name  
Suffix
Designation
Email    
Confirm Email      
Specialty
Florida Medical License
Office Address
Practice/Group Name
Address 1  
Address 2
City  
State  
Zip  
Phone  
Fax
Home Address
Address 1  
Address 2
City  
State  
Zip  
Phone  
Communications
Preferred Mailing  
Preferred Billing  
Membership Type







Education
School  
Graduation Date (MM/DD/YYYY)    
Enter the code shown: