Create a Website Account – The Latino Medical Student Association

- Name
- Prefix/Title Please indicted your preferred prefix, title, or honorific above, such as Dr., Mx., etc. (Optional)
- First Name* Please provide your first name(s) above. You may also include middle names here. (Required)
- Last Name* Please provide your last name, also known as surname or family name. (Required)
- Suffix Please indicate "Jr., III, IV," etc. here, along with terminal degrees. (Optional)
- Nickname If you would prefer to use another name, please indicate so here. (Optional)
- Login Details
- Username* This cannot be changed once created. (Required)
- Password*
  The password must have a minimum strength of MediumStrength indicator
- Repeat Password*
- Contact Information
- Email Address* Please provide your preferred email address above. This may be changed in your profile at any time. (Required)
- Phone - Country Code Please enter "1" if you have a US phone numnber.
- Phone* Required phone number format: (###) ###-####
- Email & Phone Usage*
  - I acknowledge and accept the Email & Phone Usage terms.
  Your contact information will not be published or made public. By proceeding with this registration, you acknowledge that LMSA may contact you by email and SMS text messaging and allow LMSA to do so. You may opt out of email communications at any time by selecting the appropriate option in any LMSA email or out of text messaging by sending STOP to 872-813-5672.
- Join our mailing list?
- Contact Sharing - OPT OUT
  - Do not share my information
  Please select this option if you would NOT like LMSA to share your basic contact information (name + email address) with our partner organizations. (This will be overridden if you choose to participate in a member benefit provided by an LMSA partner, such as the Sketchy Scholars Program.)
- Institution Details
- Institution* Please indicate the school or organization you are currently affiliated with. If None, please write "None" above. (Required)
- Institution City* Please provide the city in which your institution is located. (Required)
- Institution State* Please provide the state in which your institution is located. Select "NA" if your institution is outside of the U.S. and its territories. (Required)
- LMSA Region* Please select the LMSA region in which you or your institution are located. (Required)
- LMSA Chapter Affiliation*
  - Yes
  - No
  - Unsure
  - Other
  Are you affiliated with any LMSA or LMSA PLUS Chapter?
- Professional Status
- Professional Category* Please select the professional category option above that best applies to you. (Required)
- Professional Title*
- Are you the chapter advisor at your institution?*
  - Yes
  - No
  - Not Applicable (N/A)
- Current Year/Stage in Training* Please indicate your current year in training. For those currently in a gap year, please select "Other" next to your most recent training experience. For those who are no longer in training, please select "Completed Training – NA."
- Expected Graduation Date* Please provide your anticipated graduation date for your current stage in training (high school, college, etc.). Your best guess is ok! You may also type in your answer as YYYY/MM/DD.
- Match Year* For graduating medical students, please provide the year in which you will participate in the National Resident Matching Program (NRMP). (example: 2023)
- Alumni Status*
  - Yes
  - No
  - Unsure or Other
  Are you an alumnus/a of LMSA or any of its antecedent organizations? (e.g. NNLAMS, BHO/NBLHO, CMSA, LMMSA, TALAMS, HAMSA, etc.)?
- Where did you attend school while you were a part of LMSA or its antecedent organizations?
- In what year did you graduate?
- Degree(s) Obtained*
  - Bachelor's (BA; BS; BSN; etc.)
  - Master's (MA; MS; MBA; MPH; etc.)
  - Allopathic Medicine (MD)
  - Osteopathic Medicine (DO)
  - Doctoral (PhD; EdD; PsyD; etc.)
  - Other Professional Degree (JD; etc.)
  - Other Graduate Degree Not Listed Here
  - None or Not Applicable (N/A)
  If you have not obtained a degree in higher education, please select "None or Not Applicable (N/A)." (Required)
- Expected Degrees*
  - Bachelor's (BA; BS; BSN; etc.)
  - Master's (MA; MS; MBA; MPH; etc.)
  - Allopathic Medicine (MD)
  - Osteopathic Medicine (DO)
  - Doctoral (PhD; EdD; PsyD; etc.)
  - Other Professional Degree (JD; etc.)
  - Other Degree Not Listed Here
  - None or Not Applicable (N/A)
  If you are currently enrolled in a degree-granting institution of higher education, please indicate the degree you are actively pursuing. If you are not actively pursuing a degree, please select "None or Not Applicable (N/A)." (Required)
- Instructions for Medical Specialties Field
  For the field below:
  - - Medical and premedical students: please indicate the medical specialty or specialties you are interested in pursuing.
  - - Healthcare professionals, please indicate your area(s) of practice.
  - - Sponsors, exhibitors, and advertisers, please choose the field(s) you represent. If you are representing a college or medical school, please choose "Not Applicable (N/A)."
  - - For all other individuals, please select "Not Applicable (N/A)."
  You may choose multiple options. (Required)
- Medical Specialties*
  - Not Applicable (N/A)
  - Undecided
  - Anesthesiology
  - Child Neurology
  - Dermatology
  - Emergency Medicine
  - Family Medicine
  - Internal Medicine
  - Medicine-Pediatrics
  - Neurological Surgery
  - Neurology
  - Nuclear Medicine
  - Obstetrics & Gynecology
  - Orthopaedic Surgery
  - Osteopathic Neuromusculoskeletal Medicine
  - Otolaryngology - Head and Neck Surgery (ENT)
  - Pathology (Anatomic/Clinical)
  - Pediatrics
  - Physical Medicine & Rehabilitation
  - Plastic Surgery
  - Preventive Medicine
  - Psychiatry
  - Radiation Oncology
  - Radiology (Diagnostic and/or Interventional)
  - Surgery (General)
  - Thoracic Surgery
  - Urology
  - Vascular Surgery
  - Other/Not Listed
- Personal Information
- Pronouns *
- Pronouns* Please let us know which pronouns to use to best address you. You may choose one or more of the provided options below, or write in your own. If writing in pronouns, we ask that you first select "Not Listed Here" and then specify your pronouns. If you would prefer not to answer this question, please input "Prefer not to answer." (Required)
- Do you identify as a member of the LGBTQ+ (Lesbian, Gay, Bisexual, Transgender, Queer, etc.) community?*
  - Yes
  - No
  - Prefer not to answer
- Gender: How do you identify? (Optional)
- Gender Gender: Please select the term(s) that best describe(s) your current gender identity. You may select as few or as many terms as you wish, or you may type in your own terms. Data will help LMSA better tailor its programs and initiatives to its members. (Optional)
- Sexual Orientation: How do you identify? (Optional)
- Sexual Orientation Sexual Orientation: Please select the term(s) that best describe(s) your current sexual orientation. You may select as few or as many terms as you wish, or you may type in your own terms. Data will help LMSA better tailor its programs and initiatives to its members. (Optional)
- Separator 1
- Racial & Ethnic Identities*
  - American Indian or Alaska Native
  - Asian
  - Black or African American
  - Hispanic; Latino; or of Spanish Origin
  - Native Hawaiian or Other Pacific Islander
  - White
  - Not Listed Here
  - Prefer not to answer
  Please indicate your racial/ethnic identities (select all that apply). You may also select "Prefer not to answer."
- Nationalities (Optional)
- Nationalities Please click on this field to show dropdown options. Please select all that apply. (Optional)
- Final Registration Questions
- Date of Birth Date of birth is required for LMSA events that are restricted to those 21 years of age or older.
- Accommodations Please let us know if you require any form of assistance or special accommodations to participate in LMSA programming.
- How did you hear about LMSA?
  - Local chapter
  - Current member
  - Alumnus/a
  - School administrator
  - Email from LMSA
  - LMSA Newsletter
  - LMSA Website
  - Search Engine
  - Other
- Instructions for Web-Only Accounts
  By continuing with this form, you are confirming that you will only be registered as a website user and account holder, not as an LMSA member. To acquire membership, please do one of the following:
  - (1) Navigate away from the current form and complete this form instead; or
  - (2) Submit this form, visit the My Account page, and click on Change in the Membership Status tab.
  Reach out to membership@lmsa.net if any questions arise.
- Confirm Website Account Only
  NO MEMBERSHIP - ONLY WEBSITE ACCOUNT - Free
  Selecting this option and proceeding with this form will grant you login access, but no member benefits. Please select a paid option below to obtain membership status.
  
  You have selected a Group Membership. After a successful payment you will be able to invite up to %s additional members.
  
  Group Name *
  
  Group Description
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Name

Login Details

Contact Information

Institution Details

Professional Status

Instructions for Medical Specialties Field

Personal Information

Pronouns *

Gender: How do you identify? (Optional)

Sexual Orientation: How do you identify? (Optional)

Nationalities (Optional)

Final Registration Questions

Confirm Website Account Only

Credit / Debit Card Information