LPMS Online Membership Renewal

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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 Renewal

PERSONAL INFORMATION

Last Name*

First Name*

Address*

City*

State*

Zip*

Phone*

Email*

Membership Type and Dues

Select Dues to be Paid

Practicing.... $295.00/year

Academic.... $295.00/year

Part-time (20 hours max).... $195.00/year

Service (Military/VA).... $125.00/year

Retired Membership Payment.... $50.00/year

Questions/Comments

Total Amount

Payment method *

Credit or Debit Card (Processed by Paypal - Does NOT require a Paypal account.)
I will mail a check.

Credit Card Number*

Expiration Date*

Card (CVV) Code*

Card Type*

Card Holder Name*

Verification code*