WVOS Membership Application

WVOS Membership Application
Please select a member type to begin your registration:

Active Members – must be licensed as Doctors of Medicine/Osteopathic Medicine in the State of West Virginia and practicing in our surface area and have completed an accredited orthopaedic residency program. They may vote and hold office.

Associate Members – shall be any health professional that treats musculo-skeletal diseases and are duly licensed by their profession’s licensing board in West Virginia. Must be sponsored by an Active member of WVOS and will pay dues at half the rate.

Emeritus Members – shall be Active Members who have retired from active practice. They may be considered for Emeritus Membership upon their own request. Dues shall be waived; they may neither vote nor hold office.

Resident Members - shall be Active Members who haven't graduated to active practice. They may be considered for Resident Membership upon their own request. Dues shall be waived; they may neither vote nor hold office.
Select Your Member Type*
- Active Member ($175)
- Associate Member ($75)
- Emeritus Member (Free)
- Resident Member (Free)
How would you like to pay the dues?*
- Use Paypal or Credit Card at the end of this form
- Mail a check
Create Username*
Your Email*
Create Password*
Enter Password Confirm Password

Medical School*
Residency*
Internship
Fellowship
Degree
Medical License #*
Practicing since (year, i.e. 1997)
Practicing in WV since (year, i.e. 1997)
Geographic Region*
ABO Certified?
Area of Specialty #1
Area of Specialty #2
Area of Specialty #3
Recommended by
Acknowledgment*
- I understand that by providing the information above, I hereby consent to receive mail, faxes and email sent by or on behalf of WVOS. I also consent to the use of photos taken of me at WVOS meetings on the WVOS web site and other WVOS promotional materials and publications.
NOTE: WVOS dues are not deductible as a charitable contribution for federal tax purposes, but may be deductible as a business expense.
Active Member Dues*
After you click Submit, you will be taken to Paypal to complete payment.
Price:
Associate Member Dues*
After you click Submit, you will be taken to Paypal to complete payment.
Price:
Total
$0.00