New England Hand Society

New England Hand Society
2007 Membership Dues Invoice

(check one)
2007 New England Hand Society Physician Membership $150.00
2007 New England Hand Society Therapist/MLP/Nurse/PA Membership $100.00
* Your 2007 dues payment includes registration fee for the Society's Annual Meeting.
Please complete the information below and mail with payment made payable to the "New England Hand Society"
(please print/type)
First Name:
Middle Initial:
Last Name:
Practice Name:
Credentials :
Office Address:
City:
State:
Zip:
Phone:
Fax:
Email Address:
Practice Manager's Name:
Practice's Website Address:
Home Phone:
Check here if you do not want to receive Society information via your email

Remit payment by check and payable to:
New England Hand Society
c/o Susan Schaffman
26 Riggs Avenue
West Hartford, CT 06107

Pay by Credit Card :

For questions or comments, please contact Susan Schaffman, Administrator at (860) 561-5205 or email sasshops@aol.com.

Andrew E. Caputo, M.D.
President

David M. Bass, M.D.
Vice President

David Ring, M.D.
Secretary and Treasurer

Samuel Scott, M.D.
Membership Chairman

Mary Drake
Therapist Liasion