Membership

 

***********************BECOME A MEMBER, NOW!*************************

2013 WASHINGTON STATE HISTOLOGY SOCIETY –    MEMBERSHIP APPLICATION, RENEWAL

NAME:___________________________________________________HOME PHONE: (____)___________________

HOME ADDRESS:_______________________________________________________________________________

CITY: ____________________________________________________STATE: _________ZIP:__________________

EMPLOYER: _____________________________________________WORK PHONE: (____)____________________

WORK ADDRESS: _______________________________________________________________________________

CITY: ____________________________________________________STATE: _________ZIP:__________________

e-mail: (w)__________________________________________(H)______________________________________________

 

Permission to put your name and e-mail address for members only on WSHS website?  Y   N

Is this your first year of membership with WSHS? ______

I am enclosing $ ________ for the following:

____ $15.00 Annual Membership Fee

____ $28.00 Two-Year Membership Fee

____ $5.00 Student Membership   (Accredited Histotechnology Programs only)

Please make checks payable to:

WSHS

c/o Patti Erickson

4111 48th Ave SW

Seattle, WA 98116

P_Erickson@msn.com

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