Application for Membership

Washington State MCS Network

WSMCSN Home Page 

Name (required):
Email (required):
Telephone:
Years education:
Degree received:
Age:
Postal Address:
I am:	working disabled On Social Security Disability On Workers Compensation Personal (no comment) A Support Person
Life is mainly:	Please select one Interesting Boring Confusing A real blast
Please check any illness that applies:	MCS CFIDS/ME Fibromaylgia GWS Asthma Food Sensitivities Traditional Allergies