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Contact Information, Biography, Itinerary

Required fields are marked in red.

Speaker Name A value is required.
Email Address A value is required.Invalid format.

Contact Information Mailing Address A value is required.
Office Phone A value is required. Mobile Phone A value is required.
Home Phone Fax

Program Information Program Listing

A value is required. Biography (to be used in the meeting program and for verbal introduction)
A value is required.

CME I am seeking CME credit for this meeting.
I am NOT seeking CME credit for this meeting.

Travel I am driving to and from the hotel. Please skip ahead to Accommodations.
I am flying to and from the hotel. Please fill in the Arrival/Departure information below.

Arrival
I would like to be shuttled from the airport to the hotel.
Arrival Airport Airline
Arrival Date Flight Number Arrival Time

Departure
I would like to be shuttled from the hotel to the airport.
Departure Airport Airline
Departure Date Flight Number Departure Time

Accommodations

I have been told the GNS will make my room reservation.

I understand I will be making my own room reservation.

Please make a selection.

Check-in Date
Check-out Date

Guests Guest expenses are the responsibility of the speaker. Please list the following for each of your guests while at the meeting: Name, Relationship to you, Age if under 18
Example: (Jane, wife; John, son, 8)

Georgia Neurosurgical Society

Contact Information, Biography, Itinerary