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WFSA New Memberships

WFSA Membership Application (English)

Thank you very much for your interest in becoming a member of WFSA.

Please answer all the questions below. Don't forget to click the green ‘SEND’ button at the bottom of the form when you have finished, and please email memberships@wfsahq.org when you have submitted the online form so we can look out for this.

If you have any questions or require support with your application, please do not hesitate to contact us by emailing memberships@wfsahq.org
1.Legal name of your society(Required.)
2.Country(Required.)
3.Street address(Required.)
4.City(Required.)
5.Post code/zip code(Required.)
6.Contact email address for society(Required.)
7.Telephone number (with country code)(Required.)
8.Year society was established(Required.)
9.Number of active Specialist Physician Anaesthesiologists members of your society*

*These should be qualified specialist physicians who have completed a nationally recognised training programme in anaesthesiology.

Your Society will be invoiced for WFSA membership based on this number.(Required.)
10.List your society's categories of membership, including whether non-anaesthesiologists are admitted as members.(Required.)
11.Society website(Required.)
12.Preferred language of communication(Required.)
13.Society President(Required.)
14.Society Secretary(Required.)
15.Society Treasurer(Required.)
16.Date of latest society annual general meeting(Required.)
17.Date of society annual meeting or conference(Required.)
18.Total number of specialist physician anaesthesiologists based in your country (including non-members of your society)
19.Total number of other qualified providers (e.g. Anaesthetic Clinical Officers or Nurse Anaesthetists) who specialise in the administration of anaesthesia in your country
20.Official statutes or articles for your society(Required.)
No file chosen
21.Proof that your society is legally constituted and recognised in your country(Required.)
No file chosen
22.Details of the person completing this form on behalf of the society(Required.)