I will be attending the 2008 GSD Annual Meeting as a

GSD Member/GSD Applicant/ Resident Physician in a GA Training Program (NO Registration Fee)

Physician / Non-GSD Member residing in GA, NC, SC, TN, AL or FL ($50 Registration Fee)

Physician / Non-GSD Member residing in any other state 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/We will attend the Friday evening Cocktail Reception

Number attending

I/We will attend the Saturday evening Family Hoe Down and Barbecue

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 Cloister by calling 1-888-732-4752 and book under the Georgia Society of Dermatologists room block. The room block EXPIRES April 13.

When you submit this form you will be taken to a payment page to complete this registration.