NERVES 2008 Event Registration


Name________________________________________ Title___________

Practice__________________________________________________________

AANS/CNS Physician Member _______________________________________

Address__________________________________________________________

City, State, Zip_____________________________________________________

Phone________________________________ Fax_______________________

E-mail___________________________________________________________


Please check which item applies:

___ I am a current NERVES member (or currently paying dues to become a member) and would also like to attend the annual meeting ($225.00) (After April 1 - $275)

___ I am not a NERVES member but would like to attend the annual meeting ($275.00)
(After April 1 - $325)

Amount Enclosed _______________________ Check # __________________

Attach check made payable to NERVES and mail to:

Lisa Beebe
c/o The University of Texas Health Science Center At San Antonio
Department of Neurosurgery
7703 Floyd Curl Drive - MC 7843
San Antonio, Texas 78229-3900