The following text was automatically extracted from the image on this page using optical character recognition software:
Application for Membership in the - %- - County Medical Society. GENTLEMEN :-I hereby make application for membership in your Society, and, if elected, agree to support its constitution and by-laws. 1. I was born at --- - --- --- - 2. My preliminary education was obtained . - State if common school or collegiate If the latter, give name of college and f deo% W 3. I graduated in medicine. from .---- - -1 Give name of col ge in ful on the ... day of 4. My State certificate was issued - Give date of State license 5. I am a member of the following medical societies 6. I have practi at my present locat.years, and t the allowing places for the years named : - I sEC Name location and give dates. 7. I now hold, or have held, the following positions:--------------------------- Give places of trust or honor held now or in the past; prizes received, and dispensary or college appointments. 8. I am examiner for the following Insurance Companies - - 9. I am - - - -- -- ---- - State "general prat u > ndica pec' tv 10 yoc sa Stat -- -----f___street ; residence, street, telephone mbe s ce My office hours are. -- - - Respectfully, Name P . o . -- - - - -- - - - - - County ---- 6.^ - -- - - State---------------------- --------, NoTE-The above information is primarily for use in the Card Index System of the County and State, and for the oticial State and National Directory in contemplation.
Portrait of Dr. B. B. Berry, a general practitioner and graduate of the University of Louisville, wearing a suit. His name is handwritten on the back of the photo.
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