We encourage all members to register online. If you are unable to do so, please feel free to print the PDF documents and mail in the completed form(s) with your payment. Mail-In Registration Form 2020 Member/Attendee Registration 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 PhoneAnnual 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) +$0.00Annual Meeting Registration Fee*The Georgia Surgical Society annual meeting will be held at The Westin Resort, Jekyll Island, Georgia, on September 10-13, 2020. Note: After August 24th, registration increases to $500.I WILL attendI WILL NOT attendGolf (Includes Green Fees & Cart)Per Person Price: $60.00 Quantity: Fishing TournamentPer Person Price: $150.00 Quantity: Skeet ShootingPer Person Price: $100.00 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.
