Membership Costs: $25 for the application fee and $100 for the annual dues for a total of US $125.00. The application fee and dues are waived for those applying for Resident Member status For the first year post-residency and International E-Member (NEW) $25 for the application fee and $50 for the annual dues. If it has been one year or less since you completed residency training, please submit a total of US $75.00. The application fee and dues are waived for those applying for Graduate Member Status. Application must be accompanied by a non-refundable application fee and first year’s annual dues. (Dues will be refunded if membership is not granted).

Categories of Membership (CHOOSE ONE):
Active Member	Any physician who is a resident of the United States of America or Canada and who has been certified by the American Board of Dermatology, received specialty certification in dermatology by the Royal College of Physicians and Surgeons of Canada, or is certified by the American Osteopathic Board of Dermatology shall be eligible to be an Active Member.  Active members shall have full membership rights as recognized under customary parliamentary practice, including, but not by way of limitation, the rights to attend membership meetings, to participate in discussion, to vote, to be a candidate for elective office and to accept appointment to committees and councils.  Active members shall be obligated to pay all dues and assessments imposed on Active Members under Article X of these Bylaws and shall be obligated to observe all Bylaws and administrative regulations of the Society. Membership Dues for Regular Active Members = $100
Associate Member	Any physician of good standing who is a resident of the United States of America or Canada, who has had three years of full time experience in the practice of or is a teacher or graduate student of dermatology and who has had training which qualifies the person for the examination of the American Board of Dermatology, the examination in dermatology of the Royal College of Physicians and Surgeons of Canada, or eligible for the examination of the American Osteopathic Board of Dermatology shall be eligible to be an Associate.  Associates shall have all of the rights of active members except that they shall not be eligible to serve in any elective office. Associates shall be obligated to pay all dues and assessments imposed upon Associates under Article X in these Bylaws and shall be obligated to observe all Bylaws and administrative regulations of the Society. Membership Dues for Associate Members = $100
Resident/Fellow Member	Any physician who is currently participating in a training program in dermatology which is accredited by the Accreditation Council of Graduate Medical Education, and is actively pursuing the educational requirements for certification by the American Board of Dermatology or for certification in dermatology the Royal College of Physicians and Surgeons of Canada shall be eligible to be a Resident/Fellow Member.  Resident Osteopathic Dermatologists who are board-eligible or board-certified by the American Osteopathic Board of Dermatology and Osteopathic Dermatology Residents in American Osteopathic Association-approved dermatology training programs shall be eligible for the Resident/Fellow member category. Resident/Fellow members shall have all of the rights of active members except the right to hold elected office or the right to vote in elections provided, however, that when appointed to any commission, council, committee or task force, Resident/Fellow members may vote on matters before that group. Resident/Fellow members shall not be required to pay dues or assessments but shall be required to pay registration fees and fees for social events. Membership Dues for Resident/Fellow Member = Complimentary Membership Dues for 1st Year Post-Residents = $50
Life Member	An Active Member in good standing, who by reason of physical infirmity or retirement from practice, at any age, shall be made a Life Member upon written request to the Secretary and approval by the Board of Directors. A Life Member shall continue to enjoy all the membership rights of her/his prior membership category in the Society.  She/he shall not be required to pay dues or assessments but she/he shall be required to pay registration fees and fees for social events as do all members. Membership Dues for Life Member = Complimentary
Honorary Member	An Honorary Member shall be a woman or a man of outstanding attainment recommended to the Board of Directors and elected by 2/3 vote of the Board of Directors.  She or he shall enjoy all the rights and privileges of membership.  He or she shall not pay dues or any other assessments, but shall be required to pay registration fees and fees for social events. Membership Dues for Honorary Member = Complimentary
Corporate Member	A corporate member shall be a woman or man currently employed or engaged in a business activity that supports the specialty of dermatology. These members shall be non-dermatologist physicians, PhD holders or other scientists devoting a major portion of their time to dermatologic research in industry settings, or non-scientist industry leaders on a director level or higher whose careers are devoted to promoting the field of dermatology or improving dermatologic care. She or he shall enjoy all the rights and privileges of membership except the right to vote or hold an elective office. Corporate members, when appointed to any commission council, committee or task force, may vote on matters before that group. He or she will pay dues, registration fees, social events fees, and any other appropriate assessments. All applications for corporate membership shall be evaluated by the Committee on Membership and voted on by the Board of Directors. Applications for corporate membership shall have two letters of recommendation from WDS leadership. WDS reserves the privilege to limit the number of corporate members from a given company. If a corporate member leaves the company under which their membership was approved, they must notify WDS. WDS reserves the privilege to terminate corporate membership if a corporate member leaves the company under which their membership was approved. Membership Dues for Corporate Member = $100
Affiliate/International Member	Physicians who are certified in dermatology by a non-US or non-Canadian board or its licensing equivalent or who satisfy educational or professional requirements approximately equivalent to the requirements for certification by the American Board of Dermatology or the requirements for certification in dermatology by the Royal College of Physicians and Surgeons of Canada; Physicians who do not reside in the US or Canada who are certified by either the American Board of Dermatology or Royal College of Physicians and Surgeons in Canada; Practicing dermatopathologists who are not eligible to be Active or Associate members of the Women's Dermatologic Society; Non-dermatologists physicians, Ph.D. degree holders and other scientists devoting a major portion of their time to dermatologic research and/or education in academic medical centers, or teaching hospitals; Veterinarians specializing in veterinary dermatology; Dentists holding the D.D.S. or D.M.D. degree with special interests in oral/cutaneous medicine. Membership Dues for Affiliate/International Member = $100
International e‐Member • NEW •	Physicians who are certified in dermatology by a non-US or non-Canadian board or its licensing equivalent or who satisfy educational or professional requirements approximately equivalent to the requirements for certification by the American Board of Dermatology or the requirements for certification by the Royal College of Physicians and Surgeons of Canada; Physicians who do not reside in the US or Canada who are certified by the American Board of Dermatology or Royal College of Physicians and Surgeons in Canada. Membership Dues for International e-Member = $50
International Resident e‐Member • NEW •	Physicians who are certified in dermatology by a non-US or non-Canadian board or its licensing equivalent or who satisfy educational or professional requirements approximately equivalent to the requirements for certification by the American Board of Dermatology or the requirements for certification by the Royal College of Physicians and Surgeons of Canada; Physicians who do not reside in the US or Canada who are certified by the American Board of Dermatology or Royal College of Physicians and Surgeons in Canada. Membership Dues for International Resident e-Member = Complimentary
Joint WDS/EuWDS International Membership • NEW • (Clicking button will send you to a new page & simplified application)	Membership is open to dermatologist who reside outside the U.S. or Canada and who are certified in dermatology by a non-US or non-Canadian board or its licensing equivalent or who satisfy education or professional requirements approximately equivalent to the requirements for certification by the American Board of Dermatology or the requirements for certification in dermatology by the Royal College of Physicians and Surgeons of Canada. Joint WDS/EuWDS International 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 International Membership = $100
Application Date:	Month January February March April May June July August September October November December | Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 | Select Year 2007

APPLICANT INFORMATION: (Peer Apprentice)

Full Name: Birthdate: Month January February March April May June July August September October November December | Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 | Year 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 Degree or Title: Spouse Name: Preferred Mailing Address: Address: Address: City: State: Zip: Country Office Telephone Number: City/Area Code Local Number Country Code Fax Number: City/Area Code Local Number Country Code eMail Citizenship: Practice: Private Academic Other

EDUCATION INFORMATION:

Undergraduate Institution: Institution: Location: Year Completed Degree Medical or Graduate School: Institution: Location: Year Completed Degree Residency (Postgraduate Training): Institution: Location: Specialty: Year Completed Proposed Completion Degree Other Specialty Training: Institution: Location: Year Completed Proposed Completion Degree or Title Areas of Specialization: List Details Here

CERTIFICATION:

American Board of Dermatology: Board Eligible Select Year 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 Board Certified Select Year 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 Royal College of Physicians and Surgeons of Canada Board Eligible Select Year 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 Board Certified Select Year 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 Equivalent Board (other countries) Board Eligible Select Year 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 Board Certified Select Year 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 Other Specialty Boards Board Eligible Select Year 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 Board Certified Select Year 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 Other Specialty Boards Board Eligible Select Year 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 Board Certified Select Year 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 Other Specialty Boards Board Eligible Select Year 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944