First Name *

Last Name *

Email Address *

Credentials *

Pronouns *

Specialty *

City *

State/Province

Country *

Select which of the following best describes you: *Weight inclusive practicing providerLearning and working to adapt practiceNew and wanting to learn more

(OPTIONAL) Select all that apply:I identify as fatI identify as in recovery from disordered eatingI hold a certification in obesity medicine

Anything else you'd like to share (optional)

Class Determination & Payment

Please review our membership classes document below, to learn about types of membership, and annual dues for each class.

Click for link: Membership Classes

Select one: *

Founding Member

Payment Link Below (in blue):

Founding Member – $500

Regular Member

Payment Links Below (in blue):

Regular Member – $250

*Global South $200

Fellow/Resident Member

Payment Links Below (in blue):

Fellow/Resident Member – $100

*Global South $80

Associate Member

Payment Links Below (in blue):

Associate Member – $150

*Global South $120

Affiliate Member

Payment Links Below (in blue):

Affiliate Member – $100

*Global South $80

I have followed the link above, and submitted payment for my annual dues. *YesPlease contact me about scholarship opportunities.

We are looking for individuals to join leadership to help organize committees within AWSIM. Are you interested? *Yes, please reach out to meNo

We will be creating an internal directory, accessible by AWSIM members only. This will allow members to contact each other with speaking, mentoring, research, and writing opportunities. Would you like to be listed? *YesNo

You have selected a student membership, which does not have annual dues. Please click “Next” until you are able to submit this form.

Please click “Next” to proceed.

Leadership

Which of the following topics / committees interests you? *Education (developing CME events, building members’ resource bank)Membership Engagement (AWSIM newsletter, new member onboarding)Communications (media speaking/writing opportunities, conference workshops)Creating public weight-inclusive providers directoryResearchPolicyBecoming a Board MemberOther(Select all that apply)

Say more about your interest in AWSIM (optional)

AWSIM Internal Directory

Name as you'd like listed: *

Email you'd like listed: *

(optional) Phone number you'd like listed:

Practice setting and name *

(if applicable) Academic affiliation & role

Contact me for (select all that apply):Speaking opportunitiesWriting opportunitiesResearch opportunitiesTaking rotating medical students / residentsMentoring medical studentsMentoring resident physiciansMentoring practicing providersClinical consultationPatient referrals

(optional) Any additional details about yourself or practice, special areas of interest:

AWSIM Member Registration