Category of Membership: CORPORATE MEMBER
APPLICANT INFORMATION
* = REQUIRED FIELDS. INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED
MEMBERSHIP CATEGORY:
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 and improving the field of dermatology.
Membership Dues for Corporate Member = $125

APPLICATION DATE: *

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

WORK MAILING ADDRESS:
Company: *    
Address 1: *    
Address 2:  
City: *  
State: *  
Zip: *  
Country: *  
(If Other):

If you reside in a European country, you may apply for
Joint WDS-Eu/WDS membership. 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):

If you reside in a European country, you may apply for
Joint WDS-Eu/WDS membership. Click here to apply.
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  -  Do NOT publish my eMail address at all in print or on the WDS website *  
  -  Do NOT publish my contact information in print or on the WDS website *  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 (If Applicable):
Institution: 
Degree:      Year Completed: 
Dermatology Residency Program (If Applicable):
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):   

SPONSORS
List names of two members of the Women's Dermatologic Society in leadership roles that will provide letters of endorsement to the Membership Committee. One of these members should reside in the vicinity of the applicant. (Contact WDS headquarters if further information about qualified sponsors is needed).

     WDS MEMBER SPONSOR #1:   *

     WDS MEMBER SPONSOR #2:   *

LETTER OF ENDORSEMENT

Letter(s) of endorsement are required from Corporate Applicants. Please use one of the two methods below to submit:

  1. Copy and paste text in the box below to include with this form:


  2. CLICK HERE to open a new browser window to upload a digital file(s).

APPLICATION & DUES INFORMATION
INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED.
Application must be accompanied by first year’s annual dues. (Dues will be refunded if membership is not granted).

MEMBERSHIP COSTS:

  • US $125 for the annual dues
  • 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)


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.