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Independent Medical Group Alliance
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IMGA Membership Application Form
IMGA Membership Application ($1,000)
Step
1
of
4
25%
Contact Details
Name
(Required)
First
Last
Title
(Required)
Email
(Required)
Enter Email
Confirm Email
Practice
(Required)
Office Phone
Cell Phone
(Required)
Address
(Required)
Street Address
Address Line 2
City
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Armed Forces Americas
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Practice Info
Because a primary tenet of IMGA is to ensure the health and continuance of independent medical groups across the country, it is important that we ask each prospective member the following questions to verify its independent composition.
Please note, if you answer "No" to the first two questions, you may not be qualified for IMGA Membership.
Do the active members of the practice own a majority of the practice and have full control?
(Required)
Yes
No
Does your operating agreement assure continuation of physician-majority ownership and control?
(Required)
Yes
No
Are there any ongoing discussions or agreements that may result in a change to your practice’s ownership or independent status?
(Required)
Yes
No
How many practice locations do you have?
(Required)
Please indicate the specialties in your practice:
(Required)
Cardiology
Dermatology
ENT
Family Medicine
Gastroenterology
Internal Medicine
Nephrology
Neurology
OB-GYN
Oncology
Orthopedics
Pediatrics
Plastic Surgery
Pulmonary
Rheumatology
Urology
Ophthalmology
Radiology
If you have additional specialties not listed above, please list them here:
Please indicate the approximate number of providers in each of the specialties you chose above:
(Required)
E.g. Orthopedic - 18, Urology - 3
Annual Meeting
Each member group receives complimentary registration for one physician and one executive attendee to the Annual IMGA Meeting. The next annual meeting will take place on September 24 - 26, 2026 at The Stein Eriksen Lodge in Park City, UT.
If approved, will your group plan to attend the IMGA 2026 Annual Meeting?
(Required)
Yes
No
Undecided
If you selected "No", what is the reason you do not plan to attend?
If your application is approved, you'll receive registration information for the IMGA 2026 Annual Meeting.
While the 2025 data collection round has now closed, would you be interested in participating in the next benchmarking round when it opens next year?
(Required)
Yes
No
Maybe - would like more information
How did you hear about IMGA?
(Required)
Mailer
Email
Word-of-Mouth
If you were referred to IMGA, please indicate who referred you:
Are there any other medical groups that would benefit from the IMGA Membership?
At your convenience, please provide the contact information for the referred groups so we may contact them directly regarding membership.
Is there another contact we should send the membership dues invoice to?
Yes
No
Name
(Required)
First
Last
Title
Phone
Email
(Required)
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