Membership Application
Join the World Society of Arrhythmias
1
Application Form
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2
Email Verification
1. Membership Category
Please select one:
*
Physician
Allied Health Professional
Fellow in Training
Other
If Other, please specify:
2. Personal Information
Title:
*
Select...
Prof
Dr
Mr
Mrs
Ms
Mx
First Name(s):
*
Surname:
*
Age:
*
Gender (optional):
Male
Female
Prefer not to say
Prefer to self-describe
If self-describing:
3. Contact Details & Account
Email:
*
âšī¸ A verification code will be sent to the email address you used during registration. Please also check your spam folder.
Password:
*
Password must be at least 8 characters long and contain at least one uppercase letter, one lowercase letter, and one number.
Confirm Password:
*
Institute / Hospital / University:
Country of Residence:
*
City of Residence:
*
Mobile Phone Number (for WhatsApp):
*
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đą Enter your WhatsApp number without country code (e.g., 5551234567)
Work Phone Number:
Select
đšđˇ +90
đēđ¸ +1
đŦđ§ +44
đŠđĒ +49
đĢđˇ +33
đŽđš +39
đĒđ¸ +34
đˇđē +7
đ¨đŗ +86
đŽđŗ +91
đ¯đĩ +81
đ°đˇ +82
đ§đˇ +55
đ˛đŊ +52
đĻđē +61
đĻđĒ +971
đ¸đĻ +966
đĒđŦ +20
đŋđĻ +27
đ Optional - Work/office phone number
4. Professional Information
Degrees (if applicable):
Medical License Number (if applicable):
Career Level (Physicians):
Student
Fellow in training
Specialist
Early Career
Consultant
Other
Cardiology Team Role (Allied Professionals):
Nurse
Technician
Other
If Other, specify:
Year professional activity was initiated:
Job Title / Specialty (Branch):
*
Area of Expertise:
Are you a member of other scientific societies?
Yes
No
If yes, which ones?
5. Optional Information
How did you learn about WSA?
Website
Webinar
Congress
Colleagues-Peers
Social Media
Other
As a WSA member, what would be your expectations from the WSA under the mandate of education?
What would specifically work for your specific workplace or working environment?
What would work for your patients?
As a WSA member, where do you think you can contribute to the WSA mission of educating providers and patients with cardiac arrhythmia?
Let us know if you have further ideas on our membership expansion:
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