Western Trauma Association New Member Application

Member Application

Please do not submit the application until you have met all requirements.
Active membership in the Western Trauma Association is open to Doctors of Medicine or Doctors of Osteopathy who are Board Certified or eligible for Board Certification in their medical specialty. Active membership is limited to 125 individuals. In keeping with the WTA’s effort to offer a multidisciplinary educational program, no more than 40% of the membership can represent any one specialty.

Associate membership is available to non-physicians with a special interest or expertise in trauma.

For applications to be considered, candidates for must meet the following requirements.

1. Applicant must have attended a meeting (in person) within three years of the time of application.

2. Submit, to the Secretary, a completed application with a letter of sponsorship from a member of the Association.

3. Candidate must also have submitted, within three years of the time of application, a scientific abstract (not a case study) as an author or co-author for consideration by the Program Committee.

Becoming a member is then dependent on approval of the Board of Directors and an available position in the applicant’s specialty.

If application is approved you then move to Member Initiate Status. Based on specialty this could be over 5 years. As a Member Initiate and an Active Member we have a meeting attendance requirement of attending 1 out of every 3 meetings in order to maintain waitlist status/be in good standing as a member.
Name*

First NameLast Name
Credentials*
MD, DO
Email*
example@example.com
Date of Birth (enter as MM/DD/YYYY)*
01/31/2001
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mobile Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
ACS ID #
Institution/Company where you work*
Who is your Member Sponsor*
Please list your ABS Specialty and the year it was obtained*
Please list any additional ABS Specialties and the year it was obtained*
What is the most recent WTA meeting you attended?*
What year was your most recent WTA abstract submission or presentation?*
What was the title of your most recent abstract submission?*
Please upload your Abstract Submission here (most recent or presented abstract if it was within the last 3 years)*

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Please upload your CV*

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If you have your Letter of Recommendation from your member sponsor, upload it here. If not they can email it to Amy@westerntrauma.org. Your application will not be complete until we have received your recommendation letter.

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