Regular Membership Application

WAGO APPLICATION FOR REGULAR MEMBERSHIP

WAGO APPLICATION FOR REGULAR MEMBERSHIP

Please complete the following form to apply for Regular Membership to the Western Association of Gynecologic Oncologist (WAGO). You must include two (2) letters of recommendation from Active Members with this application. Note that Curriculum Vitae must be included when submitting your application. All applications are reviewed by the WAGO Executive Board.

Name
Name
First
Last
Institution Address
Institution Address
Address 1
Address 2
City
State/Province
Zip/Postal
Country
Home Address
Home Address
Address 1
Address 2
City
State/Province
Zip/Postal
Country

Describe Your Involvement

Application will be endorsed by the following two active members of the society:

1. Active Member Endorsement Name
1. Active Member Endorsement Name
First
Last
2. Active Member Endorsement Name
2. Active Member Endorsement Name
First
Last

Maximum file size: 67.11MB

Please Upload 2 Letters of Recommendation from Active Members
Did you receive your oncologic training in a hospital located west of the Mississippi (USA) or Western Provinces (CANADA)?
Do you practice west of the Mississippi (USA) or Western Provinces (Canada)?