Student Application

I hereby apply for student membership in the Michigan State Medical Society, my component county medical society, and the American Medical Association. I certify that I am a duly enrolled student at the Medical School stated in my application above, and that I agree to be governed by the Constitution and Bylaws of each organization. As part of a physician organization committed to strengthening the ethics of medicine, every AMA member pledges to uphold the Principles of Medical Ethics as interpreted in the Code of Medical Ethics (www.ama-assn.org/go/codeofmedicalethics.com), and to comply with the Bylaws of the American Medical Association and the Rules of the AMA Council on Ethical and Judicial Affairs (www.amaassn.org/go/ceja). Applicants and members of the AMA are required to disclose to the AMA Office of General Counsel any violations or alleged violations of the Principles of Medical Ethics or unprofessional conduct, including actions taken or pending regarding professional licensure, medical staff privileges, or felony or fraud convictions. Additionally, the Health Care Quality Improvement Act requires professional societies (such as the AMA) to report certain professional review actions, including denial of membership, to the National Practitioner Data Bank.