COA Membership Application

Office Contact Information

Secondary Practice Location (Optional)

Please Choose Appropriate Dues Category

Dues Subscription *
COA Membership requires that at least 90% of your professional activity must be in the field of Orthopaedic Surgery.
 
A $100 contribution to OPAC - COA's Political Action Committee is automatically included in COA membership dues. If you do not wish to contribute to OPAC, simply subtract $100 from your membership dues and mail in your check payment with the adjusted total. You will not be able to subtract the OPAC contribution from your online payment. OPAC moneys are used to support California elected officials who serve on key legislative committees and have supported COA's viewpoints on legislation. You are not limited to the suggested contribution nor are you required to contribute to OPAC.
 
PLEASE NOTE: Payments/Contributions to COA are not tax deductible as charitable contributions for federal income tax purposes. Due to federal laws limiting the tax deduction of membership dues paid to organizations involved in lobbying activities, 17% of your dues payment to COA may not be deducted as a business expense.

Specialty (check all that apply) *
Are you published in your specialty field?
Other Practice Information:
I want to receive info on the below topics (check all that apply) *
 
Find an Orthopaedic Surgeon: is a free on-line listing offered to COA members. COA will be creating a search feature on our website for potential patients to find you and your practice. New in 2016 *

Personal Contact Information - Will be kept confidential.

Payment Information

The California Orthopaedic Association uses Authorize.net to process our credit card orders. By clicking SUBMIT below, you will be directed to a page where can review your order. Choose Buy Now to continue to Authorize.net where you will then enter in your credit card information on a secure site or follow the directions to pay by check.