EmailMe Form - SOMA Lifetime Membership 2.0 Application

SOMA Lifetime Membership 2.0 Application

SOMA's Lifetime Membership 2.0 recognizes members who have made sustained contributions to the Association and to combat/TEMS medicine.

To be eligible, at the time of application, individuals must have maintained a paid SOMA membership for 5 consecutive years since 2014, unless the individual had 2 combat deployments during that time period. Individuals must also have completed at least one of the activities listed within the application below.

Application must be completed in full; no incomplete applications will be considered.

Be sure to click "Submit" when you have completed all the answers and uploaded all the required documentation.

Name
First MI Last
Credentials/Rank
Organization (if any)
Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Primary Phone
### - ### - ####
Email
SOMA Membership ID
My Current SOMA membership is:
Medic (Civilian or Military)
Physician
Professional
Emeritus
Fellow
Resident
Student
Your Lifetime membership is based on your SOMA member type. If you are a current Fellow, Resident or Student member, upon completion of your program, please indicate what membership level would apply to you.
Physician
Professional
Consecutive years of paid membership since 2014. *
I have done one of the following (may select more than one):
Committee member (current or former - please provided dates if known)
Speaker (date, event, title, etc. required for confirmation)
Panel member (date, event, title, etc. required for confirmation)
Volunteer (current or former - please provided dates if known)
JSOM Peer Reviewer (current or former - please provided dates if known)
JSOM Author (title, issue, etc.)
Supporting Documentation
Before uploading any documentation, be sure to redact any personal information you do not want shared.
Evidence/confirmation of service as outlined above.

Supporting Documentation