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

First Last

Title

Practice/Group Name

Practice Address

Street Address Address Line 2 City State ZIP Code

Practice Phone

Practice Email

Home Address

Street Address Address Line 2 City State ZIP Code

Home Phone

Home Email

Preferred Choice for WSNS Correspondence

Home
Work

Subspecialties

EDUCATION: (School Name/Location & Years Attended)

Premedical Education

Medical School

Residency

Fellowship

Date of Board Certification

Board Eligible

Yes
No

Professional Society Memberships

MEMBERSHIP TYPE

One-Year Membership Dues

Active - $150.00 - $150.00
Affiliate (PA/ARNP) - $100.00 - $100.00
Junior (Resident) - $25.00 - $25.00
Emeritus - $0.00 - $0.00

TOTAL

$0.00

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.

Supporting the practice of neurology in Washington state

Supporting the practice of neurology in Washington state

Apply for Membership

Contact Information

EDUCATION: (School Name/Location & Years Attended)

MEMBERSHIP TYPE