Pennsylvania Neurological Society Membership Survey
Name
*
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
In order of importance, please number in order issues that you would like to see the society address (1= most important; 6= least important)
*
1
2
3
4
5
6
Education Conferences (bringing the latest in cutting edge education)
Public education campaigns
Networking opportunities between PA Neurologists
Third Party Payors
Malpractice Reform
Improving quality of care of neurology services in PA (ie. increasing primary stroke centers in rural areas)
If you are interested in a leadership position within the Pennsylvania Neurological Society, please select the committee(s) you are interested in below:
Executive Committee
Annual Meeting Committee
Constitution/Bylaws Committee
Public Relations Committee
Legislative Committee
Neuroimaging Committee
Pediatric Neurology Committee
Third Party Payor Committee
Public Health Committee
Would you prefer a Saturday and/or Sunday conference held in:
Hershey, PA
Philadelphia, PA
Pittsburgh, PA
Rotated annually between Hershey, Philadelphia and Pittsburgh
What aspect(s) of the annual conference would most likely convince you to attend:
Submit
Should be Empty: