Member Application

This is the electronic version of our application. If you would rather use a paper application, you may download it and then fax or mail it to:

c/o The Elk Street Group, LLC
21 Elk Street
Albany, NY 12207

There are two steps:

  1. You need to submit this application. If you don’t know some of the information, don’t worry, we can get it from you later.  If you are applying as an individual not associated with a facility, please follow the instructions below.  If you are a facility, please ensure that all information on this application form is the same as is listed on the New York State DOH website. If you are a PC, PLLC, or LLP, please so indicate. After you submit the application, it will take you to the payment page.
  2. You can either pay with a credit card using Paypal by clicking on the “Buy Now” button (this will transfer you to the secure Paypal site) or send a check payable to NYOBS in payment of your yearly membership fee of $1000 to the address at the end of this application. If you forget, don’t worry, we will bill you. There is also an option of Life Membership of $25,000, but that can’t be placed on Paypal.

If you are not affiliated with an accredited facility, associate membership is available for medical professionals or affiliate membership for other interested individuals or companies. Please be aware that there are some limitations for associate and affiliate members and it does not confer voting rights.

Please enter the appropriate information on each line.  You will be assigned a username and password after we have received payment.  At that point you will have access to the members only portion of the website.

We encourage you to allow us to allocate a portion of your dues for our PAC fund by checking the box in the application below.  We are very limited in the amount of funds from NYOBS that we can use for the PAC and it is critically important for us to be able to support those politicians that share our goals.  We also encourage you to contribute an additional amount for the PAC.

If you have any problems with this form, please send an email to the address at the bottom of this page.

  • This application constitutes my consent to receive all communications sent by or on behalf of the NYOBS via the communications vehicle of its preference, including but not limited to Email, Fax, Telephone, Regular Mail, or special expedited mail services.

    I hereby certify that the above information is correct to the best of my knowledge.

    If you would prefer to not use this electronic application, you may download our application and fill it out and either mail or fax it.

Page last modified on: January 1st, 2020