First Name *
Last Name *
Phone *
Email *
Address
Unit
City
State —Please choose an option—AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
Zip
Medical School
Medical Degree —Please choose an option—MDDO
Year of Graduation —Please choose an option—20222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970
License State —Please choose an option—AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
MD/DO License Number
License Status —Please choose an option—ActiveRestrictedRetiredVoluntaryCharity CareN/A
Specialty
Board Certified —Please choose an option—YesNo
Sub-Specialty
Email
Phone
Fax
Appointment Phone
Preferred Contact Method —Please choose an option—PhoneEmail
What committee(s) would you like to join? * Membership/MentorshipScholarshipFundraisingProgramming
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.
$130
Annual Membership
Attract new patients through our online directory
Professional and personal support from other Black female physicians
Mentorship
Community Service
Professional enrichment
$260
MSMMS T-shirt
Acknowledgement on website
$520
Commemorative MSMMS plaque
Select a membership option.
You will be redirected to PayPal to complete your payment.
Select a MembershipGoldPlatinumVibranium