WSSP | Member Application | pathologyconnection.com

Membership Application

Membership Category

Active Member ($150.00)
Pathology Assistant Member ($75.00)
Resident Member ($45.00)

Applicant Information

Please select the category that best describes your status:
Fellowship/Residency Program:
Expected Graduation Year:

Prefix
Professional Title
Designation/Degrees
First Name
Middle Name
Last Name
Suffix
Birth Date (MM/DD/YYYY)
Gender
Email
Contact Phone
Website URL

Applicant Addresses

Preferred Mailing Address

Office Address

Include my work information in the provider directory of the website.
Company Name
Office Address Line 1
Office Address Line 2
Office Address Line 3
Office City
Office State/Province
Office ZIP/Postal Code
Office Country
Office Phone

Home Address

Home Address Line 1
Home Address Line 2
Home Address Line 3
Home City
Home State/Province
Home ZIP/Postal Code
Home Country
Home Phone

Professional Information

Share my WSSP membership information 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 purposes than those stated.
Is your practice majority pathology?

Please submit your CV: (as a single PDF including the relevant information listed below)

General medical education and internships (schools, hospitals, dates, and degrees)
Details of special training and experience in pathology
Medical societies of which you are a member (local, state, national)
Pathology societies of which you are a member (local, state, national)

Via Upload:
Via Email
Via Mail:
Membership Department
Washington State Society of Pathologists
1100 E. Woodfield Road, Suite 350
Schaumburg, IL 60173
Via FAX: (847) 517-7229

Member Contributions

General Contribution:
Please round up my membership dues to $200.00 and donate $50.00 to lobbying efforts
Lobbying Contribution: ($50 suggested)
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 or contributions used for lobbying activities are not deductible as a business expense.
Total Donation Amount:

TOTAL REGISTRATION FEE:

Payment Information (must be made in U.S. dollars)

CheckCredit Card

Card Type
Name As It Appears on Card
Credit Card Number
Expiration Date (MMYY)
Card Verification Number
Billing Information
Billing Street Address
Billing ZIP Code

If paying by check, make check payable to: Washington State Society of Pathologists

Mail payment to:
Washington State Society of Pathologists
Two Woodfield Lake
1100 E. Woodfield Road, Suite 350
Schaumburg, IL 60173

Enter Security Code: 078584