UWHA Membership Application 2019/2020
A $6 monthly membership fee will be automatically deducted from your paycheck.

If your department is Family Medicine, please pay your annual membership fee of $72 via PayPal (mail@uwha.org) or mail a check to the following address:

UW House Staff Association
PO Box 45373
Madison, WI 53744

For more information about UWHA, check out our website at www.UWHA.org
Email address *
First Name *
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Last Name *
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Department *
Email Address *
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Referring Resident:
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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 $6.00 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 $72.00.
Significant Other's Email Address
If you have a significant other who is interested in receiving complimentary updates from UWHA regarding social events etc., please provide his/her email address:
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