WMA - Members

Members

Application form: ASSOCIATE MEMBERSHIP (this applies to individual physicians)

Please complete this application IN FULL, in English, French, or Spanish.
Surname
First Name
Title
Medical Speciality
Organization
Work Address
P.O. Box
ZIP/City
Country
Home Address
P.O. Box
ZIP/City
Country
Daytime telephone
Fax
E-mail
I HEREBY APPLY FOR INDIVIDUAL ASSOCIATE MEMBERSHIP OF THE WORLD MEDICAL ASSOCIATION (Please click on the appropriate box)
Annual membership	€ 37.00
Five-Year Membership	€ 152.00
1) By cheque payable to The World Medical Association C.I.B. Building “Le J. Keynes” General Secretariat, B.P. 63, 01212 Ferney-Voltaire Cedex, France 2) Or for Bank transfer Name of the Bank: SOCIETE GENERALE 4, avenue Voltaire 01210 Ferney-Voltaire, France National bank transfer (in France) Code Banque Code guichet N° de compte Clé rib 30003 00109 00037260094 56 International bank transfer (IBAN) BIC FR76 30003 00109 00037260094 56 (Euros) SOGEFRPP We regret that we cannot accept credit card payment for membership dues.
Membership includes a 24-hour accident death insurance; a privilege for WMA Associate Members. The insurance will pay US$ 10,000 for death due to any accident PLUS US$ 10,000 for death due to accident in a commercial airline for a total of US$ 20,000.
Please indicate the Beneficiary Name for the insurance
Beneficiary Address
Send all mail to	Office address Home address
Language preference for communications	English French Spanish
N.B.: The WMA, Inc. is a tax-exempt organization. Membership dues are tax deductible.

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