2025-2026 Membership Form

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Please complete the form and submit your dues to join Iowa Medical Partners today!
This information will be used to compile the Member Directory and needs to be filled out YEARLY. The names of members may be shared with our sponsors. All communications and resources will only be sent through official IMP platforms.

Name *

Address *

City *

State *

Zip Code *

Phone Number *

E-Mail Address *

Gender *

Occupation

Name of Spouse / Partner *

Department of Spouse / Partner *

Expected Graduation Year of Spouse / Partner *

Names and Ages of Children (if applicable)

Iowa Medical Partners posts pictures to our Instagram, do you consent to being in pictures on our Instagram page? *

Yes

How did you hear about us? *

Post Card received in the mail

E-Mail forwarded by spouse / partner

Internet Search

Facebook

I was a member last year.

Other:

Do you have any special dietary needs in your family we should be aware when considering food for events?

IMP provides postpartum meals for members. Would you be willing to take a dinner to a family this year?

Yes

Clear selection

Would you like to be added to our Groupme for Playgroup?

Yes

Clear selection

DON'T FORGET TO HIT THE 'SUBMIT' BUTTON BELOW AND PAY YOUR DUES ON THE WEB PAGE!

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