IPPS Representative Application

Integrated Physician Practice Section Membership Application
The Integrated Physician Practice Section (IPPS) gives voice to, and advocates for, issues that impact physicians in practice settings who advance physician-led integrated care. Shape AMA policy on issues that impact integated care by serving as your organization's IPPS representative.

Health care organization information

Please provide information about the organization you will be representing.
Health care organization name*
Number of physicians in organization*
Number of physicians in organization *
Organization location*

Street Address

Street Address Line 2

CityState

Zip Code
URL to your organization's leadership webpage *
e.g., online listing of your organization's executive leadership or senior physician leaders

Representative information
Physician applicant name*

First nameLast nameSuffix (MD, DO, etc.)
Title*
Email*
example@example.com
Current AMA membership is required to represent your organization in the AMA-IPPS.*

Yes, I am a current AMA memberNo, I am not currently an AMA member

Certification and Submission
Individual certification

I certify that the information in this application is accurate and true.
Certification*

I certify that the boxes checked in this application accurately reflect the organization’s characteristics.
Signature*

Clear
Should be Empty: