[Medical Association Application: Ralph Bourquin Miller, MD] Page: 1 of 4
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TEXAS MEDICAL ASS CIATION
Application for Membership-Date /
(To be made in duplicate, original to be retained by County Society Secretary, duplr e to be m led to Texas Medical Association, 1801 N. Lamar, Austin,
Texas, as soon as a~plicfr as been elected and his dues have been collected by County Society Secretary.)
To the e County Medical Society
Gentlemen: I hereby mak application for membership in the above Society, and, if elected, agree to abide by its constitution and by-laws, as they now exist
or may hereafter be a en d.
Full Name a&K 7//7Sex,/ -Specialty _/ '-
Please Print first Mi e Last '7 One Only for Directory
Address: Permanent-Offic / % / /4 ,- / , /7 /1/b 7
R dreet No. or P./ X City State
Residence ~2 i 5 7e ?'-e /e / K& CN
v A - 1 1. A ,, I ;- r I -
Present (if different)
Birti
BrotLicense to Practice Medicine in Tex sDd1)/a7t/- w '"l SSrial Num-r ~-
members must have permanent license Monl Day Year7
hi: Date ,Parentage: Father's Name d
Month Day Year
Place/M D Mother's Maiden Name
City State '
hers a SistersC 6'St-,-,e , fK/,4" /,/ & /d', (
Name Addressriage: Spouse /c= b //o
Former Name
Date of Marriage /l - /
onth Day Y
If Spouse Has Died, Date of Death_. e
YearFormer Addres
Place of Marriage /'A)C 5 '.( f$ Z/Children 6-ne
Name
Education: Preliminary-
Academic llheo .,city A bA
Name of College
Location
Medico o)CoOee LcatAn
Name of College LocationInternship /11M/C 5 -& "
Name o Hospital
Residency d c//4e/L a. /-.
Name of H1spitalState
Years A tended
Years Attended
Location
LocationDegree Date Degree Received
Mo. Day Yr.Degree Date Degree Received
Mo. Day Yr.Dates
/ 93 2Dates
Postgraduate
Name of Institution
Location
Certification by Specialty Board / $ 44d &/2 d5/
Specialty
i!6 < c -' (OVER)Mar
Address
Years Attended
Date Certified
I
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Texas Medical Association. [Medical Association Application: Ralph Bourquin Miller, MD], text, July 19, 1957; (https://texashistory.unt.edu/ark:/67531/metapth586609/m1/1/: accessed July 5, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu.; crediting University of Texas Health Science Center Libraries.