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