The SF Neurological Society is a CMA-accredited provider of Continuing Medical Education

SAN FRANCISCO NEUROLOGICAL SOCIETY
WINTER DINNER MEETING
 Tuesday January 15, 2008 - 6:30 - 9:00 PM
6:30 – 7:00 PM – Registration and Reception
7:00 – 8:00 PM – Dinner /8:00 – 9:00 PM Presentation

Directions
VINTNERS INN  |  4350 BARNES ROAD, SANTA ROSA, CA 95403 707.575.7350

Register online (and/or renew/enroll SFNS Membership dues online) and make secure credit card transactions or print a personalized invoice to mail in with a check

OR use form below and register by e-mail, fax or mail: (click here to print meeting/registration flyer)

First Name                                               Initial              Last Name                                                                           

Degree                            Specialty r Neurology r Neurosurgery r Neuroradiology r Neuropathology r Other

Institution                                                           Dept/Mailstop                                                                                 

Street Address/Suite                                                                                                                                                

City                                                                  State                Zip Code                                                                 

Phone                                                                            Fax                                                                                    

*E-mail: (VERY IMPORTANT)                                                                                                                                  

 Registration Fees (please check the appropriate boxes)

                                                                                                         Rec’d by Jan 14          After Jan 14

                                                                                                                                                and onsite

SF Neurological Society Members & Guests:

                 Dinner Meeting (1 CME Credit)                                           r $80.00                     r $85.00

Non-Member Physicians & Guests:

                 Dinner Meeting (1 CME Credit for physicians)                     r $90.00                     r $95.00
                

Includes Reception &  Dinner

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

Requesting CME credits for guests? r Yes    r No

Payment Total: $                                                       Payment Method:

Registration includes:  Reception, sit-down dinner and lecture. (1 CME credit hour)

Register online, by E-mail, Fax, or Mail PRIOR to 12:00 PM January 14, 2008 to the Society Office as follows:

·         MAIL the registration form with a check made out to San Francisco Neurological Society, 2226A Westborough Blvd. #409, South San Francisco, CA  94080 – please do not mail registrations after January 14, 2008.

·         EMAIL the above information to kbertani@sfneurological.org.

·         FAX your registration form to the SFNS Office at 415-206-0385.

The Tax ID number for the San Francisco Neurological Society is 51-0478773. Cancellations must be made in writing (by e-mail or FAX) to kbertani@sfneurological.org or FAX 415-206-0385, by January 14, 2008 for a full refund.

Special Needs & Request for E-mail address

If you need special arrangements, such as a special diet or accessibility assistance, please call 415-206-9603 or e-mail Karen Bertani at kbertani@sfneurological.org. *Your e-mail address will not be given out without your consent. The Society needs to have an e-mail address on each member so that electronic newsletters, meeting announcements and other important information about the society can be distributed in the most efficient, cost effective manner.

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