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.
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 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.
