Qualifi cation
Registrants will have completed an initial qualifying, credentialing,
or vocational degree-producing program in any recognized medical
discipline or vocation.
Qualifi cation may be demonstrated by submission of a photocopy
of a graduation certifi cate or diploma along with verifi able contact
information at the awarding program or school.
Experience
Registrants will have completed at least one year of professional
practice in their medical vocation or discipline after completion of
an initial qualifying program or school.
Experience may be demonstrated by submitting verifi able contact
information and a photocopy of a membership certifi cate or similar
documentation in a professional society, association, institution, or
employment.
Currency
Registrants will, at the time of registration, be current with respect
to licensure and/or institutional registration in their respective
vocational discipline.
Proof of currency may be demonstrated by submitting a photocopy
of any current professional discipline credentials including but not
limited to state licensure or registration.
Membership
Registrants (Fellows and candidates) must maintain an active
membership in the WMS in order to maintain their registry status.
Membership may be demonstrated by providing a current membership
number, or a completed membership application and dues payment
with the registry application.
Fee Structure
Upon application to the registry program, applicants will pay an
initial one-time fee of $95. Registrants will pay a $25 annual fee
to maintain their candidate and Fellow status for all subsequent
years to remain active. Retroactive reviews for credit will incur a $50
administrative fee.
Disclosure
The WMS is under no obligation to keep the names of individuals
listed in the registry confi dential and those accepting inclusion in
the registry thereby give permission to list their names publicly in
Society related publications and website applications.
F e l l o w o f t h e A c a d e m y o f W i l d e r n e s s M e d i c i n e TM
Application
N A M E
C R E D E N T I A L S
A D D R E S S
C I T Y
S T A T E
C O U N T R Y
P O S T A L C O D E / Z I P
T E L E P H O N E
E - M A I L
Fees
Academy registration fee
$95 $__________
Retroactive credit review
(OPTIONAL)
$50 $__________
Join WMS if not a current member
Doctoral $160
Non-Doctoral $100
Resident $75
Student $50
TOTAL $________
Payment
Check enclosed. Make checks payable in U.S. funds
to Wilderness Medical Society
Charge to:
Visa
Mastercard
Card #_______-_______-_______-_______ Exp ___/___
S I G N A T U R E
Disclaimer
Consistent with Academy principles, the WMS does not vouch for the compe-
tency of any individual listed in the registry. The Academy's role is limited
to documenting and verifying that individuals in the registry have met the
educational criteria established by the Academy. Documented education
and/or experience should not be used to verify or validate an individual's
competency to perform any specifi c task or skill.
I have read and agree to the Professional Conduct Statement and understand
that the Director of the Academy of Wilderness Medicine will review and make
fi nal approval of all applicants to the candidacy of Fellow of the Academy of
Wilderness Medicine. Appeals will be made in writing to the Academy Direc-
tor. If not able to be resolved, these will be reviewed by the WMS Executive
Committee with fi nal decision authority resting with the WMS President.
Signature of Applicant
Date
Please submit in envelope provided at right.
PO Box 1897
·
Lawrence, KS 66044
785.843.1235
·
www.wms.org
WMS Membership amount $__________
