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:  Please Provide:
First Name:
Middle Name:
Last Name:
Birth Date (MM/DD/YYYY): - -
Website URL:
Preferred Mailing Address:
IPPS Discussion Listserv
Short Biography (max 8000 characters):
(optional for Provider section)