Apply for Membership


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

CONTACT INFORMATION

Name:
Title:
Practice/Group Name:
Practice Address:
Practice Phone:
-
Practice E-mail:
Home Address:
Home Phone:
-
Home E-mail:
Preferred Choice for WSNS Correspondence:
Subspecialties:

EDUCATION: (School Name/Location & Years Attended)

Premedical Education:
Medical School:
Residency:
Fellowship:
Date of Board Certification:
Board Eligible:
Professional Society Memberships:

MEMBERSHIP TYPE

One-Year Membership Dues:*
Total:
Please verify:

Upon completing the form and clicking "submit," if any funds are due to complete the application for membership, you will be directed to PayPal to make the payment.  You do not need a PayPal account to make a payment.



INQUIRIES: Contact Becky Constantine, Association Executive, at the WSNS Office at 206-956-3635 or send emails to admin@washingtonneurology.org.