Application for Membership

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

  Contact Information

• Name
  First Last
• Title
• Practice/Group Name
• Address
  Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe
• Phone
• Email*
• CAP Information Share
  • I do not want my WSSP membership information shared with CAP
• CAP will only contact you for business such as: notifications of calls to action, membership renewal and information on meetings. Your information will not be used for any other purpose than stated above.

  Education Information

• Medical School
• Residency
• Internships

• Professional Information

• Medical society memberships
• Are you board certified?
  • Yes
  • No
• If so, when?
• Do you limit your practice to pathology?
  • Yes
  • No

• Membership Type

• Membership Dues
  • Active MD - $150.00
  • Resident - $45.00
  • Pathology Assistant - $75.00
• WSSP Donation - Optional
  Donate to lobbying efforts (2017: balanced billing) - $50 suggested
• Total
  $0.00
• Credit Card
  American Express

  Discover

  MasterCard

  Visa

  Card Number Expiration Date Month010203040506070809101112 Year20172018201920202021202220232024202520262027202820292030203120322033203420352036 Security Code   Cardholder Name
• 
  In most cases, a portion of the WSSP dues may be deductible for tax purposes as professional or business expenses. For your records, please note that the Revenue Reconciliation Act of 1993 states that association dues used for lobbying activities are not deductible as a business expense. As a result, $50.00 of your WSSP dues for 2017 cannot be deducted as a business expense for federal income tax purposes.
  
  INQUIRIES Contact Linda Krause, Association Executive, at the WSSP Office at (206) 956-3624 or send emails to admin@wsspath.org.