Application for Membership


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

Contact Information

Name:
Title:
Practice/Group Name:
Address:
Phone:
-
E-mail:*

Education Information

List schools and hospitals, years attended, and degrees received

Medical School:
Residency:
Internships:

Professional Information

Are you certified by the American Board of Pathology?
If yes, when and in what specialty?
Are you certified by the Royal College of Physicians & Surgeons?
If yes, when and what specialty?
Do you limit your practice to pathology?
Do you limit your practice to clinical pathology?
Special training and experience in pathology:

Membership Category

Membership Dues:*
Total:
Please verify:

Upon completing the form and clicking "submit," you will be directed to PayPal to make the payment.  You do not need a PayPal account to make a payment.

INQUIRIES: Contact Darla White, Association Executive, at the PNWSP Office at 206-956-3642 or email admin@pnwsp.org.