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Membership Application

Medical Student

    General Information

    First Name *

    Last Name *

    Phone *

    Email *







    Medical School

    Medical Degree

    Current Year


    Internship Years

    Graduate School

    Graduate Degree

    Year of Graduation

    License State

    MD/DO License Number

    License Status


    Board Certified


    Board Certified


    What committee(s) would you like to join? *

    Membership Application


    Conditions of membership: Every person who seeks membership to Mary Susan Moore Medical Society of Houston (hereafter “MSMMS”) must be an MD, DO, DPM, or in training towards these degrees at the time of application and initial appointment and continuously thereafter, demonstrate: 1) ability to work and relate to other members, and members of other medical societies, organizations, visitors and medical community leaders and in general, in a cooperative, professional manner that is essential for maintaining an environment appropriate to quality and efficient medical action; 2) To be of high moral character and to adhere to generally recognized standards of professional ethics.

    • Regularly attend meetings, and be regularly involved in the activities of the society.

    • Vote on all matters presented at the general and special meetings of the society and committees, of which she is a member.

    • Hold office at any level in the society and to be chairperson of a committee, provided she satisfies the specific qualifications for the position involved.

    • Contribute to the organizational and administrative activities of the society, including service to the society and special functions and committees, faithfully performing the duties of any office or position to which elected or position to which appointed.

    • Participate equitably in the discharge of the society functions as reasonably assigned by the applicable committee chairperson or other authorized member.

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