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Membership Form - New or Renewal
The 2010 Membership is due on March 31, 2010. Please return this form to confirm your ongoing interest in membership; please do so even if you are a Resident/Student or Emeritus Member so we can keep our membership and mailing lists up-to-date. Click Here for to download a Word version that you can fill in and mail. After opening in Word, print or save to your computer.
Name (please print)
Department, Room
Hospital / Lab
Number & Street
City, Prov, Postal Code
Country (if not Canada)
Telephone
Fax
Email
Sponsor for New Members (must be an OAP member)
Name of sponsor
Signature of sponsor

Please return this form and your cheque (if applicable) made out to the Ontario Association of Pathologists to the Secretary Treasurer:

Dues
*Check One*	Category	Dues Amount
	Renewal	$100.00
	New Membership	$100.00
	Resident/Student	No cost
	Emeritus Member	No cost

Dr. Christina MacMillan OAP Secretary Treasurer Pathology & Laboratory Medicine Mt. Sinai Hospital 600 University Ave. Toronto ON M5G 1X5
Phone	416.586.1575
Fax	416.586.8628
Email
Web	www.ontariopathologists.org

Last Updated 2010-03-02