IPPS Membership Application

Application Form

IPPS members are charged annual dues based on the membership year January 1 – December 31.

Membership renewal payments are due every year on January 1 to continue membership with IPPS.

When a new membership application is processed, prospective members must pay the full amount of the membership fee; however, depending on when you join, your dues will be used to pay for the remainder of the current dues year cycle, and any balance will be applied as a prepayment toward the next year.

Contact Information

  • Please select the Occupation that best fits:
  • Prefix:
  • First Name:
  • Middle Name:
  • Last Name:
  • Suffix:
  • Designation/Degrees:
  • Birth Date (MM/DD/YYYY):
  • Title:
  • Website URL:
  • Preferred Mailing Address:
  • Gender:
  • Email:
  • Provider Directory:
  • IPPS Discussion Listserv:
  • Short Biography (max 8000 characters):
    (optional for Provider section)