Application for Membership

Thank you for recognizing the importance of supporting your local obstetrics community and applying for membership in the Washington State Obstetrical Association.  Your participation and financial support is essential as we continually strive to strengthen our organization.

Contact Information


Name:
Title:
Address:
Phone:
-
E-mail:*
Date of Birth:

Education: (School Name/Location and years attended)


Undergraduate School:
Medical School:
Internship:
Residency:
Other Training:

Professional Information

Hospital Appointment - Active:
State License #:
Membership in other medical professional societies/associations:
Check all that apply:

Membership Type

Membership Dues:*
Total:

Upon completing the form and clicking "submit," you will be directed to PayPal to pay your membership dues.  You do not need a PayPal account to make a payment.

Please verify:



INQUIRIES

Contact Darla White, Association Executive, at the WSOA Office at 206-956-3642 or by email.