If you
are not currently a member of the Georgia Neurosurgical Society, we would
like to take this opportunity to invite you to join your state specialty
organization. Membership dues are $125 per year.
Full Name Req.
Practice Name
Office Address
City, State Zip
Home Address
City, State Zip
E-mail Req.
Phone
Mobile
Fax
Medical School & Year
Residency & Year
Name of Spouse
Please list the
name, address and phone number of two recommending GNS members:
After
submitting this form, you will be able to pay the $125 application fee
online. If you would rather pay with check, please mail check along with
your CV to GNS, 6134 Poplar Bluff Circle, Suite 101, Norcross, GA
30092.
