Name* First Last Degree Practice Name* Address* Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone*Email* HiddenUsername Password Enter Password Confirm Password WRA membership category Rheumatologist Non-rheumatologist physician Non-physician healthcare professional Practice Manager/Administrative Professional Resident Fellow Medical Student Retired physician Are you a nurse, PA, or other (please specify):If you are a resident, fellow, or medical student, please state where you currently are in training:Note: industry-employed professionals are not eligible for membership in the WRA.Payment Type* Credit Card Paid in Conference Registration Transaction ID of Conference Registration TOTAL $0.00 CREDIT CARD* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month010203040506070809101112 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Security Code Cardholder Name Δ
