Fill out this form and when you click on the "submit button" on the bottom it will send your information to Suzette Izac MEMBERSHIP CHAIR. You will get an address to send  your dues or You will have the option to "pay online" with PayPal.
 
WSET Membership Online Form: Dues are paid according to the calendar year. They may be paid any time during the year and will be current for the remainder of that year.

Send a quick note to the president

Please mail check to:

Cindy Francke, R EEG/EP R, CNIMWSET Treasurer

2100 Western Ave # 57

Seattle, WA 98121

First Name
Last Name
Address
City
State
Postal Code
Home Phone Number
Work Phone Number
Credentials
Main E-mail
Employer
Address
City
State
Postal Code
Years of Experience in Electroneurodiagnostics	1-5 6-10 11-15 16-20 21+
I am a NEW MEMBER	YES NO
I am a RENEWAL MEMBER	YES NO
Membership	MD. / PH.d. $145 Technologist Membership $45 Student fee: $20.00
I request a "Certificate" for framing	YES NO
Name of school
Date you began program
Program Length	12 month program 18 month program 24 month program
Program Other (optional)
Program directors name
Program directors E-Mail Address
I have read the above and agree to the terms	YES NO
Your signature / date
Additional Information
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