I will be attending the 2007 GSD Annual Meeting as a

GSD Member/GSD Applicant  (NO Registration Fee)

Non-GSD Member/Resident of GA, NC, SC, TN, AL or FL ($50 Registration Fee)

Non-GSD Member/Resident of all states not listed above ($300 Registration Fee)

Name (req.)

Practice/Company Name

Address

City, State  Zip

E-mail (req.)

Office Phone

Mobile Phone

Fax

Guests will be accompanying me

Spouse/Guest and Children's Names (please include ages of children):

I will attend the Friday afternoon buffet lunch in the Exhibitor Hall

I/We will attend the Friday evening Cocktail Reception

Number attending

I/We will attend the Saturday evening Family Beach Party

Number attending

I will play in the GSD Golf Challenge, Saturday afternoon.  All golf fees will be the responsibility of the player, paid directly to the course pro-shop prior to the start of the Challenge.  If you cancel inside of 48 hours, your room account will be charged. 

My Handicap

Spouse/Guest Name

Spouse/Guest Handicap

I would like to play in a foursome with

Make your accommodations reservation at the Ponte Vedra Inn & Club by calling 800-234-7842 and book under the Georgia Society of Dermatologists room block.

You will receive an email confirmation upon submission of this form and subsequent notices, reminders and announcements regarding the meeting in the coming months

.