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 at admin@wsoa.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 Middle Last Credentials (MD, DO, etc.) Group / Hospital Address* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code PhoneEmail* Year You Began Practice1970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021HiddenYears Between Now and Date Practice Began*@March 21, 2023Membership 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 Paid as Part of Proliance Paid in 2021 for annual mtg reg Check Number* TOTAL $0.00 Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month010203040506070809101112 Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Security Code Cardholder Name INQUIRIES: Contact the Executive Director, at 206-956-3621 or admin@wsoa.org.NameThis field is for validation purposes and should be left unchanged. Δ
