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Membership Levels 
 Platinum Membership:     $750+
 Gold Membership:   $500-$749.99
 Sustaining Membership:   $250-$499.99
 Nonmember Friend of Iowa Medicine:   $100-$249.99
 Resident Membership:
   $50
 Student Membership:   $25


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Donation

* Mandatory fields
*First name
Middle Initial/Name
*Last name
Suffix
Designation
e.g. M.D., D.O.
Preferred Name
*Organization
The parent company you work for (e.g. health system)
Title
Date of Birth: Full
Date of Birth: Year Only
Date of Birth: Month/Day
*Primary Email
The email address you want to receive communications at.
Secondary Email
*Business Address
Business Address2
*Business City
*Business Zip Code
*Business County
*Business Phone
Mobile Phone
Fax
Med School Grad Year
If a student, please enter the anticipated graduation date.
Clinic Staff
Select if a clinic staff member.
*Amount ($USD)
 Payment frequency
*Donation Type
Comment
 


The Iowa Medical  Society is a 501(c)6 non-profit organization. 515 E Locust St. Ste. 400 50309

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