Step 1 of 2 50% HiddenToday MM slash DD slash YYYY Thank you for recognizing the importance of supporting your local orthopaedics community and applying for membership in the Washington State Orthopaedic Association. Your participation and financial support are essential as we continually strive to strengthen our organization. The WSOA has six classes of members, defined as follows: Active Member: $295 Any medical doctor or doctor of osteopathy, licensed to practice in the State of Washington, who devotes at least ninety percent (90%) of his or her practice to orthopaedic medicine. Active Part-Time Member: $200 Any medical doctor or doctor of osteopathy, licensed to practice in the State of Washington, who practices orthopaedic medicine 20 hours or less per week. Affiliate Member: $125 Any physician assistant or ARNP licensed to practice in the State of Washington, who devotes a significant portion of his or her practice to orthopaedic medicine. Any individual with a non-MD degree (PhD, MPH, MS, BS, and BA) AND who devotes a significant portion of his or her time to musculoskeletal research. Retired Member: $100 Any active member of the corporation who has fully retired from active practice. Resident/Fellow Member: No Fee Any physician enrolled in an orthopaedic residency or fellowship program in the state of Washington. Military Member: $75 WSOA is proud to offer a reduced membership dues rate for our Active Military Orthopaedic Surgeons of $75 per year WSOA is also extending two new pricing models for 2020: 1) 50% off dues for the first two (2) years in practice for Active, Active Part-Time, Affiliate, and Active Military members. 2) For practices that choose to join/renew all their physicians with one payment, receive 20% off your total dues. If you would like to be invoiced as a practice, please email WSOA Executive Director Emily Jones at firstname.lastname@example.org. Please choose the option that best describes you:* I am applying to be a new member. I am renewing my membership. Contact InformationName* First Last Credentials (MD, DO, etc.) Address* Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone*Email* Year You Began Practice197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020HiddenYears Between Now and Date Practice Began*2021Membership ApplicationEducation Please list school name, location, and years attended.Medical School* Residency* Fellowship Professional Society Memberships PaymentMembership Dues* Active: - $295.00 Affiliate (PAs and ARNPs): - $125.00 Active Military: - $75.00 Active Part-Time: - $200.00 Retired: - $100.00 Resident/Fellow Member: No fe - $0.00 Coupon Optional - Donate to the WA State Orthopaedic FoundationInformation on the WSOFSelect donation amountWSOF Donation: $25.00 - $25.00WSOF Donation: $50.00 - $50.00WSOF Donation: $100.00 - $100.00WSOF Donation: $200.00 - $200.00WSOF Donation: $500.00 - $500.00WSOF Donation:Other - Other WSOF Donation Amount Payment Type* Credit Card Check Invoice Check Number* TOTAL $0.00 CREDIT CARD American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month010203040506070809101112 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Security Code Cardholder Name INQUIRIES: Contact Emily Jones, Executive Director, at 206-956-3621 or email@example.com.