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We invite you to join the LPMS by completing the online application below.
If you have any questions, you may contact the Lafayette Parish Medical Society Office at 337-232-2860 or email us at staff@lpms.glacoxmail.com.

LPMS Online Membership Application


PERSONAL INFORMATION



PROFESSIONAL PRACTICE INFORMATION
(IF APPLICABLE)


EDUCATIONAL INFORMATION


MEMBERSHIP APPLICATION AND QUALIFICATION QUESTIONS


Members are governed by the Lafayette Parish Medical Society (LPMS) Principals of Medical Ethics and must comply with the bylaws of the LPMS. To assist in upholding these standards, please provide answers to the following questions. If you answer yes to any of these questions, please email us with full information.



I am aware that information submitted in this application will be verified. I hereby authorize other organizations having information relating to this application, including governmental and regulatory entities, to release any and all such information. I understand that any false or misleading statement made on my application may be grounds for denial of membership or probation or censure by, or suspension or expulsion from the medical society.
The foregoing information is true and complete.


Membership Type and Dues



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