Graduate Medical Education

Resident Spouse Association

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Membership Form

So glad you are considering joining the Resident Spouse Association!  As a member, you will be able to participate in all of our activities and build a network of friends and others who understand your situation.  Just fill out the following form, print it out and send via regular mail along with a dues payment of $30.  Make your check out to Resident Spouse Association.

Mail to: Stephanie Joyce, RSA Treasurer, 2531 N. 70th St., Wauwatosa, WI 53213

Required fields are marked with an asterisk *.

Your Name

*First Name
*Last Name
Middle Initial

Spouse's Name & Specialty

Name
Specialty

Contact Information

*Street Address
Address (cont.)
*City
*State/Province
*Zip/Postal Code
*Home Phone
*E-mail

Children's Names & Ages

Name
Birth date
Name
Birth date
Name
Birth date

Questions, Concerns, Comments

If you have any questions, or encounter problems filling out this form, please email: rsa.mcwah@gmail.com