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 For online registration please click the button above. Payment can be made by credit card or an invoice can be printed and mailed in with a check. Confirmation and receipt will be sent to you immediately by e-mail and an extra receipt can be forwarded to one additional e-mail address for record keeping. Alternatively, registration can be made by printing this page and mailing it with a check or credit card information to the Society office or sending it by FAX with credit card information. Please include an e-mail address if a receipt and confirmation is required.

First Name                                                Initial                  Last Name                                                                  Degree                       

Institution                                                                                                   Dept/Mailstop                                                                          

Street Address/Suite                                                                                                                                                                                     

City                                                                                                      State                      Zip Code                                                              

Phone                                                         Fax                                  E-mail:                                                                

Registration Fees: (please check the appropriate boxes) fax form with credit card information to 650-347-4975 or mail with a check made out to San Francisco Neurological Society, 2226A Westborough Blvd. #409, South San Francisco, CA 94080

                                   By February 4, 2011   After February 4 and onsite

SFNS Member Meeting: r $255.00   r$285.00 (Includes CME, Syllabus, Presidents Reception, Breakfasts & Breaks)

Non-Member Meeting: r $365.00   r$395.00 (Includes all of above plus complimentary 2011 SFNS Membership)

Nurses /Allied Health r$155.00   r$175.00 (Includes CEU, Syllabus, Presidents Reception, Breakfasts & Breaks

*Student/Resident/Fellow r$ 55.00  r$ 75.00 (Includes CEU/CME, Syllabus, Presidents Reception, Breakfasts & Breaks)

Industry Representative (non-exhibitor): r$425.00 (Includes Syllabus, President's Reception, Breakfasts & Breaks)

*(Please e-mail a letter of training status to apacia@sfneurological.org)

Accompanying Person r $ 75.00 (includes Presidents Reception and Breakfasts, children under 12 are FREE and welcome to attend the Presidents Reception and Continental Breakfasts)

rSaturday Evening Reception & Society Dinner $100 per person: people X $100.00 each = $

Name(s) of Guest(s): (please print):                                                                                                                                                                          

r SF Neurological Society Membership Renewal for 2011 - $100.00 (2011 Membership dues must be current to obtain the SFNS Member discounted registration fee.)

Payment Method: r Visa r Mastercard r American Express r Check Payment Total: $                                                      

Card Number                                                                                                                                                                      Expiration Date                      

Cardholder Name Signature                                                                                                                                                                                                  

Special Needs: If you need a special diet or accessibility assistance, please call 650-288-5339, e-mail apacia@sfneurological.org or list here: The SF Neurological Society is incorporated as a 501(c) (6) non-profit organization. Tax ID number: 51-0478773. Cancellations made by February 18, 2011 will receive a full refund less a $50 handling fee.

For more information:
Amanda Pacia
Executive Director
San Francisco Neurological Society
2226A Westborough Blvd. #409
South San Francisco, CA  94080
Phone: 650-288-5339  Fax:  650-347-4975
E-mail: apacia@sfneurological.org

The San Francisco Neurological Society is an organization of physicians with a dedicated interest in the clinical neurosciences. The Society is committed to the continuing medical education of its members and has an obligation to its members and to the public to provide ongoing educational programs designed to improve patient care and foster scholarly activity in the neurosciences. This obligation includes not only imparting to the membership an increased understanding of neurological diseases through lectures on clinical and basic research, but also making them aware of community and public health issues related to neurological illnesses and preventive medicine. The Society is a CMA-accredited provider. Physicians attending this course may report up to 8 hours of Category 1 credit toward the California Medical Association Certificate in Continuing Medical Education and the American Medical Association's Physician's Recognition Award.