NEW YORK STATE THORACIC SOCIETY (NYSTS)
A Chapter of the American Thoracic Society

NYSTS

2013 NYSTS ANNUAL SCIENTIFIC ASSEMBLY
February 1-2, 2013
New York Medical College, Valhalla, NY

Registration & Membership Form

Please provide the following information
* Required Field

  Contact Information:

  Registration & Membership

   Select the appropriate option:

  $275 - Practitioners (Includes Registration, Meals and 2013 NYSTS Annual Membership Dues)

  $150 - Resident Trainees, Allied Practioners, Physician Assistants and Respiratory Therapists (Includes Registration, Meals and 2013 NYSTS Annual Membership Dues)

  $100 - Hands-on EBUS session (Limited availability)

   Session time slot preference:

  Credit Card Information

  Total payment due: $

  Cardholder's Name (as it appears on card):

 

If you prefer, you may print the form and send it with a check payable to NYMC-CME to:

New York Medical College
Margaret Astrologo
Office of Continuing Medical Education
Room 229 - Vosburgh Pavilion
Valhalla, NY 10595

Completed forms may also be faxed to (914) 594-4699
Please allow up to3 business days for processing

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