Follow the steps to fill out the application accurately and efficiently.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling out your name in the designated field to identify your application.
3. Provide your office address in the next section, ensuring you list your preferred mailing address.
4. Input your home address similarly, making sure it is the address where you prefer to receive communications.
5. Enter your best contact phone number, allowing the organization to reach you easily.
6. Fill in your email address and grant permission for PSG to include it in their database for internal use.
7. Provide your date of birth to help verify your identity.
8. Input the name of the medical school you attended along with your graduation year.
9. Detail your residency, including start and end dates, to outline your training experience.
10. If applicable, fill in your gastrointestinal fellowship information, including dates.
11. Enter your medical license number and the state in which it was issued.
12. Indicate the year you began practicing gastroenterology.
13. Confirm your board certification status in internal medicine and gastroenterology by checking 'yes' or 'no' and providing dates accordingly.
14. List any current memberships you hold in various medical societies.
15. State your fellowship status if applicable.
16. Choose your desired membership type by checking the corresponding box, and provide details such as your Chief of Service's name and email if you are applying as an associate.
17. Select your method of payment for the membership dues and provide the necessary payment details, ensuring the billing address matches.
18. Review all entered information for accuracy and completeness before submission.
19. Once you are satisfied, save your changes, download the form, and then either print it for mailing or share it as needed.

Complete your application online today to join the Pennsylvania Society of Gastroenterology.