Company Membership Form

CONFIRM MEMBERSHIP LEVEL

OPT-IN TO AUTO-RENEWAL

If you'd like your membership to auto-renew each year, please select the check box below. If you'd like to manually renew each year, leave the check box below unchecked.

PERSONAL INFORMATION

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PRACTICE INFORMATION

We have received regular requests from members to be able to search for other members by several aspects of practice characteristics. Please provide the information below so members with similar practices can connect with you!

 

DEFINTIONS

 

  • -Practice Type: How would you classify your practice. If you feel your practice type is not represented, please select the best option below, then email Linden describing your practice classification for consideration.
  • -Number of Surgeons: How many doctors does your practice currently have
  • -Surgeon Names: Please list your doctors' names, separated by a comma
  • -Number of Offices: How many locations are included in your practice
  • -Total number of Full-Time Equivalencies: Not including yourself, what is the equivalent to full time employees does your practice have. Example: If you have 10 full time and 12 part time employees, you would enter 16 FTEs.
  • -Practice Software: What practice software does your practice use? If you do not see your software listed, please select the best option below, then email Linden your practice software (e.g. Oral Surgery Exec) and maker (e.g. DSN).
  • -Professional Certifications: List any professional certifications you'd like to share with members
  • -Years in OMS: How long have you been working in the OMS field, administratively or otherwise
  • -How did you hear about SOMSA?: Let us know how you heard about us! Please choose the best option.

CREATE YOUR SOMSA ACCOUNT

If you would like to manage your Society of OMS Administrators account (i.e., view donation history, renew membership, etc.), please create a login name and password below. Your password must be at least eight characters long, and contain at least one number.

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