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Welcome Letter - Get Now DOC

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					                            Seattle Surgical Society
                            2010 Annual Meeting Registration
                                      Friday, January 15, 2010
                                       (Westin Seattle Hotel)

REGISTRATION INFORMATION
                                                                 First
  Last Name:                                                   Name:
     Address:


         City:                                             State:                 Zip:
          Tel:                      Fax:                             E-mail:

REGISTRATION FEES

MEETING PACKAGE (ALL INCLUSIVE)                    Cost             # Attending                Amount
  Seattle Surgical Society Member                 $200.00
  Non-Member Physician                            $225.00
  Resident/Fellow/Student                         $150.00
* Registration includes lunch and annual banquet: Check here if you will attend lunch
MEETING ONLY                                      Cost          # Attending                    Amount
  Physician                                       $125.00
  Resident/Fellow/Student                         $75.00
* Registration includes lunch: Check here if you will attend lunch
BANQUET ONLY (Museum of Flight)                   Cost          # Attending                    Amount
  Physician                                       $100.00
  Resident/Fellow/Student                         $75.00
  Spouse/Guest _                                  $75.00

                                                        TOTAL AMOUNT ENCLOSED:

PAYMENT OPTIONS
                  CHECK ENCLOSED           VISA        MASTERCARD              AMERICAN EXPRESS
      Name on Card:
              Address:
        Credit Card #:
   Exp. Date: MM/YY
Mail registration and payment to:                                        Tel: 425-953-4757 | Cell: 206-794-7022
        Seattle Surgical Society                                         Fax: 206-319-4601
        PO Box 2459                                                      Email: sclentz@aol.com
        Lynnwood, WA 98036
Check out our website at www.seattlesurgical.org

				
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