2022 Member/Attendee Registration & Annual Dues Member/Attendee Name* First Last Additional Guest Name First Last Relationship to Member/Attendee (Spouse or Guest) Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Enter Email Confirm Email Contact Person First Last Contact Person PhoneTotal $0.00 2022 Annual Membership Dues*Dues are required for all members both attending and not attending the annual meeting. Nonpayment of dues will place member on an inactive list.Member +$100.00Affiliate (PA/NP) +$50.00Non-Member (Guest of Society) +$0.002021 Annual Membership Dues*Members and affiliate members need to be current on dues in order to be considered a member in good standing and to attend the 2022 meeting.I have already paid my 2021 dues.Member +$100.00Affiliate (PA/NP) +$50.00Non-Member (Guest of Society) +$0.00Annual Meeting Registration Fee*The Georgia Surgical Society annual meeting will be held at The Westin Resort, Jekyll Island, Georgia, on September 15-18, 2022. The cost to attend is $400. Note: After September 1st, registration increases to $500.I WILL attendI WILL attend and rolled over my 2021 registration payment to 2022I WILL NOT attendGolf (Includes Green Fees & Cart)Per Person Price: $60.00 Quantity: Fishing TournamentPer Person Price: $150.00 Quantity: Beach Walk/RunNo Fee Price: $0.00 Quantity: TennisNo Fee Price: $0.00 Quantity: BabysittingNo Fee Select All Friday Evening Saturday Evening For babysitting services, please note child(s) name(s) and age(s).Total $0.00 Credit Card* Card Details Cardholder Name Only submit this form once, please allow the page 10-20 seconds to load your confirmation.
