UWHA Membership Application 2024-25
A $10 monthly membership fee will be automatically deducted from your paycheck.  

If your department is Family Medicine, please pay your annual membership fee of $120 via PayPal (mail@uwhamadison.org) or mail a check to the following address:  

UW House Staff Association
3156 Muir Field Rd. #301
Madison, WI 53719

For more information about UWHA, check out our website at www.UWHAmadison.org
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Email *
First Name *
Last Name *
Mailing Address *
Cell Phone Number *
Department *
Mark your stage of training: *
Email Address *
Spouse Email Address *
We will send emails to you and your spouse for better communication and planning!
Referring Resident:
What kind of events are you most interested in? *
Required
UWHA Membership Statement and Authorization of Dues Deduction *
By submitting this form, I certify my intent to be a member of the University of Wisconsin House Staff Association (UWHA).  I hereby authorize the University of Wisconsin Hospital and Clinics to deduct from my monthly salary check, the amount of $10.00 for dues payable to UWHA.  If my department is Family Medicine, I will mail or pay via PayPal my annual dues in the amount of $120.00.
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