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STATE MEDICAL ASSOCIATION OF TEXAS
APPLICATION FOR MEMBERSHIP-(ORIGINAL-DUPLICATE*) DATE _Sept 2, 195_3
To the Bexar ___ ___ ___ County Medical Society
Gentlemen: I hereby make 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 amended.
1. I was born at-_San__Antonio, Texasa------------------------- Date of Birth _J 1Vy 15, 198-
2. My preliminary education was obtained Doulas High, St. Peter Claver' s Academy,San Antonio, Tex,
Give name and location of schools and colleges and date and character of degree or degrees.
ward- - Univ.-,.-,1%32;mi t h o21gag ortampt n,.Mass B.9. L4 IOW gad-Univ.
Wash., D.C., M. D. 1944
3. I graduated in medicine from---owardUniversity_ $chool. -dik e
Give name and location 8f co lege 1
on the 17th----------- day of-March---------------------------19- --"
4. My certificate or license, to practice medicine in Texas, is dated -Noyember_,-----------19 6I. and bears the
serial numberA3 -935Q
5. I am a member of the following medical and special societies:- NONE----------------------------
------------------- ------------------------------- --------------------------------------------------------------------------
---------------------------------------------------- -------------------------------------------------------------------------
6. I hold or have held the following positions: -Frx. rn --at_-Freed ents Hosp ital-19 .-hhIntere _-
Give places of trust or honor held now or in the past;
--Homer- G. -Phiilips-Hospital 9445--Student N, Y.- Post (-raduate M-ed. Szho -_(2-mos.)
prizes received. internships, college appointments, or graduate courses of instruction, with dates.
- --- a d ---------------- - --------- --------- ------ - --------------------------------- - - - -- ------------- ---------------
7. I have practiced at the following places for the years named: t Louis a -Mo . -19.m6-_95O.
-- n n -Txs_ 11 3------------- ----- --- ----------------------------------------------------------- -------------
8. I am in general practice-I specialize in-give special attention to G-yn-- -b---------------
9. My office is at_81QS..-Hacke' - -- street; residence---C----
City-anAntonio----------------------------State- Texas
Respectfully, Name--_R31 Annt__el1]ie'er----
Print full name, then sign.
(NOTE: Other data of interest or importance may be given on the reverse side of this sheet. This information becomes a matter of permanent
record, and should be full and accurate.)
REPORT OF BOARD OF CENSORS
Reco ended by We, your Board of Censors, have had the above application
under consideration, and beg to report on same.
unfavorably o ae
(Any specific remarks should be noted on the back of application.)
.W. H ick,- * Z Lied-- B4.Surgery
k J E. Guy, M. O ertified B4 Int. bed.) BOARD OF
-}CE N------ -' - - - - - - -
Elected-Rejected-- ----------------------19
------------- --------Secretary,
- ------------ County Medical Society.
*NOTE: To be made in duplicate, original to be retained by the County Society secretary, the duplicate mailed to the Secretary, State Medical
Association of Texas, 700 Guadalupe St., Austin, Texas, as soon as received from the applicant.