2010-2011 Dues
New York Society of PM&R

For the calendar year 2010-2011

The "New York Society of Physical Medicine and Rehabilitation" is collecting dues for the 2010-2011 calendar year:

Active Members $150

Associate Members (Residents with letter from Program Director) $45

Residents Group rate of $10 for 5 or more residents from one program joining

Checks should be made payable to the "New York Society of PM&R". Please mail checks and the completed form as soon as possible to:

The New York Society of PM&R
C/O Valerie Davis
12 East 41st Street, 15th floor
New York, N.Y. 10017
Tel: 212-684-4670

First Name:		Last Name:
Middle Initial:		Degree:
Home Address: (Please indicate preferred mailing address)			Home Office
Street:		Apt:
City:		State:
Zip/Post Code:		County:
Phone:		Fax:
E-Mail Address:
Office Address:
Street:		Suite:
City:		State:
Zip/Post Code:		County:
Phone:		Fax:
PM&R Residency?	Yes No
Year Completed :
Institution:
*Please note: 50% of current dues are tax deductible.
Comments: