Category of Membership: JOINT WDS/EuWDS MEMBER
APPLICANT INFORMATION
* = REQUIRED FIELDS. INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED
MEMBERSHIP CATEGORY:
JOINT WDS/EuWDS MEMBER:
Membership is open to dermatologists who reside outside the U.S. or Canada who meet one of these criteria: (1) certification in dermatology by a non-US or non-Canadian board or its licensing equivalent; or (2) satisfaction of education or professional requirements approximately equivalent to the requirements for certification by the American Board of Dermatology; or (3) satisfaction of the requirements for certification in dermatology by the Royal College of Physicians and Surgeons of Canada.

Joint WDS/EuWDS Members are eligible to serve on WDS committees, be mentors, submit articles, and be considered for scientific events. These members may vote, but are not eligible to hold office. They will receive all materials produced for members by WDS and EuWDS and are obligated to pay all dues and assessments imposed by the WDS and EuWDS bylaws and to observe all bylaws and administrative regulations of the Women's Dermatologic Society and the European Women's Dermatologic Society.
Membership Dues for Joint WDS/EuWDS Member = $125

APPLICATION DATE: *

Name: *
First * Middle Last *
Degree or Title: *
Date of Birth: *  *  *  * 
Spouse’s Full Name:

WORK MAILING ADDRESS:
Company (If Applicable):  
Address 1: *    
Address 2:  
City: *  
State:   
Zip:   
Country: *  
If you do not reside within one of the countries listed in the pull down menu,
you may not apply for WDS/EuWDS Joint Membership. You may apply as:
  • Affiliate/International Member (Click here to apply)
  -OR-
  • International E-Member (Click here to apply)
Phone: *  
City/Area Code    Local Number *   Country Code *  
Fax Number:  
City/Area Code *   Local Number *   Country Code *  
eMail: *  
Citizenship: *  
Practice: *  
(If Other):
Preferred Mailing Address:
HOME MAILING ADDRESS:
Address 1: *    
Address 2:  
City: *  
State:   
Zip:   
Country: *  
(If Other):
Phone: *  
City/Area Code Local Number *   Country Code *  

PRIVACY POLICY:
  -  You may publish my contact information on the WDS website to be viewed by members only *  
  -  Do NOT publish my eMail address at all in print or on the WDS website *  
  -  Do NOT publish my contact information in print or on the WDS website *  

EDUCATION INFORMATION
Undergraduate Institution:
Institution: *  
Degree: *      Year Completed: *  
Medical or Graduate School:
Institution: *  
Degree: *      Year Completed: *  
Dermatology Residency Program:
Institution: *  
Year Completed/Proposed Completion: *   
Post-Dermatology Residency Fellowship (If Applicable):
Institution: 
Year Completed/Proposed Completion:   
Areas Of Specialization In Dermatology (If Applicable):
Institution:
Position Or Title (If Applicable):   

CERTIFICATION
  *  
Dermatology Board Eligibility Year: *  
 Dermatology Board Certification Year: *  
(use only if 'Equivalent Board' was selected) Board & Country

Dermatology Board Eligibility Year
 Dermatology Board Certification Year
(use only if 'Equivalent Board' was selected) Board & Country

Dermatology Board Eligibility Year
 Dermatology Board Certification Year
(use only if 'Equivalent Board' was selected) Board & Country

*** PLEASE NOTE:
If one of your 3 board choices as selected above is answered "Equivalent Board (Other Countries)", please describe in the text box below your dermatology equivalent board certification standards, which can include information about the examination, specific dermatology training, etc.

ADDITIONAL INFORMATION

Has your license to practice medicine in any jurisdiction ever been limited, suspended, or revoked *

Have your privileges at any hospital ever been suspended, diminished, revoked or not renewed? *

Have you ever been denied membership or renewal thereof, or been subject to disciplinary action in any local, state, or national medical society? *
Are there any charges pending resolution by a Board of Medical Examiners in any state in which you have practiced medicine? *

Have you ever been sanctioned by the Board of Medical Examiners? *

SPONSORS
If you have been invited to apply for WDS/EuWDS Joint Membership by a member of the EuWDS, please enter their name and contact information.

     EuWDS Member Name:   

     EuWDS Member Email:   

     EuWDS Member Phone Number:   

Otherwise, list names of two members of the Women’s Dermatologic Society from whom the Membership Committee may request letters of endorsement.

     WDS MEMBER SPONSOR #1:   

     WDS MEMBER SPONSOR #2:   

APPLICATION & DUES INFORMATION

Upon acceptance of your membership application by the EuWDS, 1/2 of the membership fee will be transferred to EuWDS. Membership applications are reviewed and approved by the Board of Directors twice yearly.

INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED.

MEMBERSHIP COSTS:

  • US $125 for the annual dues ($62.50 US goes to each society)
  • IF YOU DO NOT INCLUDE FIRST YEAR DUES YOUR APPLICATION WILL NOT BE ACCEPTED.

METHOD OF PAYMENT:

  • Visa
  • MasterCard
  • American Express

    Click the 'SUBMIT and PROCEED' button below and you will be taken to step 2 in the application process

PAYMENT OPTIONS:

       1 Year Membership - US $125.00
       3 Year Membership (discount) - US $350.00
       3 Year Membership (discount) - US $375.00 (US $350 dues + $25 Legacy Contribution)

Application must be accompanied by first year’s annual dues. (Dues will be refunded if membership is not granted).

REFERRAL CODE:


Additional Comments:






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*Note: Use of the name of Women's Dermatologic Society
and/or the Society logo on business or in any advertisement is prohibited.
**Membership applications are reviewed and approved by the Board of Directors twice yearly.