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Membership Form - New or Renewal

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

CategoryDues Amount

 

Renewal $100.00
 New Membership$100.00
 Resident/StudentNo cost
 Emeritus MemberNo 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
Phone416.586.4553
Fax416.586.8589
Email

Webwww.ontariopathologists.org
Last Updated 2008-05-03