The
2008 Membership is due on March 14, 2008. Will you 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.(PLEASE PRINT)
Name
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
Do you wish to receive mailings? q No
Dr. B. Mullen, OAP Secretary Treasurer Pathology & Laboratory Medicine Mt. Sinai Hospital 600 University Ave. Toronto ON M5G 1X5
