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
First Last
Title
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Email
Date of Birth
MM
DD
YYYY
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:
- Practice limited to OB/GYN
- Diplomate of OB/GYN Boards
- Family Practicioner
- AAFP Member
Membership Type

Please note: WSOA will invoice you for the amount indicated below in the "TOTAL" field
Membership Dues*
- Active Physician Member - $135.00
- Affiliate Midwife Member - $135.00
- Affiliate/Non-Physician - $135.00
- Resident - $0.00
- Fellow - $0.00
TOTAL
$0.00
Credit Card

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
INQUIRIES Contact the WSOA Office at 206-719-2421 or email admin@wsoaonline.org..

Washington State Obstetrical Association