Mission Statement

 The Western Society of Electrodiagnostic Technologists is the oldest society of its kind in the United States. It was founded to help in the continuing education of Electrodiagnostic technologists in the western states.

 

 

Membership Form 2010

The way this works is - 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
then a new page will open and give you 2 options of payment

  1. You will get an address to send  your dues
    or

  2. 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.

Membership received after October 1, 2009 will be active until December 31, 2010


 Suzette Izac R.EEG T MEMBERSHIP CHAIR

 

 

You must fill out form completely for it to submit correctly.  Thank you.

 

First Name   Last Name     Credentials 

Address:
City:           State   Postal Code:
Home Phone Number                   Work Phone Number:
Our Website is our main source of communication with our members.
It is updated monthly and includes WSET Newsletter, Meeting information, Technical tips, Yellow Pages, Job postings and much more. PLEASE INCLUDE YOUR EMAIL ADDRESS
Main E-mail:    
Employer
Address:
City: State Postal Code:
Years of Experience in Electroneurodiagnostics 
I am a NEW MEMBER, I request a "Certificate" suitable for framing & wallet size membership card.  YES   NO 
I am a RENEWAL MEMBER, I request a "current wallet size membership card", YES    NO 
Active Membership (Dues $45.00 US)   NEW    RENEW 
Associate/*Student (Dues 20.00 US)    NEW    RENEW  
I am a NEW Student MEMBER, I request a "Certificate" suitable for framing, YES     NO  
Name of school 
Date you began program 
12 month program  18 month program    24 month program    
Other 
All students MUST INCLUDE a letter of current enrollment from your school/program director.(an E-mail from your director will be accepted)
Write down this information so you will have it when you mail  your letter to
Cindy Francke
PO Box 328
Sequim, WA 98382

Cindyjo@earthlink.net


Please e-mail any questions regarding membership to Suzette Izac R. EEG T    

                                      MEMBERSHIP CHAIR
 
Program directors name  
& email address 
I have read the above and agree to the terms Yes    No 

 

Your signature / date:

                                                                             Type your full name,

 When form is submitted this will be used as your full signature. This will be an understanding of previous paragraph (Your Signature)

 PLEASE PRINT AND SIGN prior to submitting.

Do you plan to pay by - snail mail?   - online PayPal?    (this information will help Suzette know where verify payment for membership cards.)
Date

Comments

Please make sure all information is correct before you hit submit
Once you click on the submit button you will see a confirmation that your membership has been mailed, please scroll up and pay using PayPal.

Web Site maintained for WSET by - Frances Perdue R.EEG T.,CNIM

Copyright © 2010

 Western Society of Electrodiagnostic Technologists

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