Association of VA Anesthesiologists Membership Application

Membership is annual and is charged on an annual basis. The membership fee is $100.00.

If you are a current member, we thank you! Please complete this application so we have an updated membership database.

If you have any questions, please contact our office at 206-794-9124.

-- AVAA Team

First Name *

Last Name *

Degree (MD, PhD, etc.)

Mailing Address *

City *

State *

Zip Code *

Phone Number *

VA Email Address *

Personal Email Address *

VA Medical Facility Affiliation *

VISN *

Please indicate your profession: *

Anesthesiologist

Resident

Medical Student

Committee Membership

I am interested in joining the following committees. You will be notified when approved for committee appointment.

Education

Patient Safety

Advocacy

Membership dues are charged on an annual calendar basis. *

New Member Joining Today ($100)

Current Member ($100)

Resident (Free)

Medical Student (Free)