Complete the following form and attach the appropriate documents as listed below to complete the Online Registration and to be considered for membership at WNAM.

If you do not have access to a printer complete the online registration and we will contact you to arrange a WNAM package mailed to you.

WNAM Registration Form Step 1

First Name (required)

Last Name (required)

Your Email (required)

Date of Birth (MM/DD/YYYY)(required)

Address (required)

City (required)

Province (required)

Postal Code (required)

Phone Number (required)

MMAR #

Medical Condition(s) & Symptoms (required)

Physician's Name (required)

Physician's Address (required)

City (required)

Province (required)

Postal Code (required)

Phone Number (required)