[Medical Association Application: William Weaver Nichol, MD] Page: 1 of 4
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TEXAS MEDICAL ASSOCIATION
Application for Membership-Date -
(To l . made in duplicate, original to be retained by County Society Secretary, duplicate to be mailed to Texas Medical Association, 1801 N. Lamar, Austin,
Texas, as soon as applicant has been elected and his dues have been collected by County Society Secretary.)
To the 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.
Full Name Sexi.izlSpecialty 3_._
Please Print First Middle Last One Only for Directory
Address: Permanent-Office <
Street and No. or P. O. Box City State
Residence Gl' 3 >>0. T
Present (if different)
License to Practice Medicine in Texas: Dated Serial Number
Members must have permanent license Month Day Year
Birth: Date Parentage: Father's Name
Month Day Year
Place Mother's Maiden Name
City State
Brothers and SistersName
Address
Marriage: Spouse
Former Name
Date of Marriage
Month Day Year
If Spouse Has Died, Date of Death
Children ;
NameEducation: Preliminary
City
Former Address
Place of Marriage
AddressState
Academic
Name of College Location Years Attended Degree Date Degree Received
Mo. Day Yr.
Medical - -:: I7&IL&I.1:Y790 L.. S
Name of College Location Years Attended Degree Date Degree Received
Mo. Day Yr.
Internship e s3 1 . n FrUne s*. 9
Name of Hospital Location Dates
Residency 0 04o
Name of Hospital Location Dates
Postgraduate : - . j..Certification by
Name of Institution Location
Specialty Board General .u1>e.L
Specialty
(OVER)Years Attended
Date CertifiedLI
I-
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Texas Medical Association. [Medical Association Application: William Weaver Nichol, MD], text, December 3, 1958; (https://texashistory.unt.edu/ark:/67531/metapth586707/m1/1/: accessed July 18, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting University of Texas Health Science Center Libraries.