May 22 Neuromodulation Caucus Tribute to Mark S. George

Join the new APA Caucus on Neuromodulation

to celebrate & honor

Mark S. George, M.D.

The 2023 Recipient of the APA Award

for Research in Psychiatry

Monday, May 22, 2023

6:00 to 8:00 PM

Minna Gallery, 111 Minna Street, San Francisco, CA 94105

Cocktails and Hors d'oeuvres to be served

All proceeds from this event will be donated to the Foundation for the Advancement of Clinical TMS (FACTMS), developed by the Clinical TMS Society to further advance the field of TMS.

Important note: on this same evening, the APA Foundation Ball begins at 7:00PM at the San Francisco Museum of Modern Art (SFMOMA). SFMOMA is a 4 minute walk from Minna Gallery.

You could do both events: https://www.apafdn.org/News-Events/Events/The-APA-Foundation-Benefit

Your Full Name & Title (for Name Badge)*

First Name (Given Name) Last Name (Surname) and Title

Your Email - for reminders*

Your Mobile Number - for reminders*

Country CodeArea CodePhone Number

Select your ticket(s) first,

then, if you are able, select a tribute to Dr. Mark S. George

NOTE: SPONSORS & TRIBUTES GIVEN AFTER 5/13/2023 WILL NOT BE INCLUDED IN THE PRINTED MATERIALS.

Options - pick a ticket, then if able select a tribute to Dr. George*

Ticket(s)$150.00

BUY TICKET(S) HERE

Quantity

Tribute Amount $100.00

Tribute donation to event for Mark S. George; this option does not include tickets, please purchase tickets above.

Donor Tribute to Dr George$300.00

Donor printed acknowledgement; this option does not include tickets, please purchase tickets above.

Colleague Tribute to Dr. George$600.00

Printed acknowledgment; this option does not include tickets, please purchase tickets above.

Patron Tribute$1,000.00

Printed & email acknowledgment; this option does not include tickets, please purchase tickets above.

Corporate Donation$2,000.00

Printed & email acknowledgment, as well as verbal acknowledgment at the event; this option does not include tickets, please purchase tickets above.

Total $0.00

If you purchased multiple tickets, give us the first name (given name) and Last Name (surname) of the other attendees for Name Badges

By signing below, I am acknowledging that I am registering and paying for a reception to celebrate, honor, and pay tribute to Dr. Mark S. George as part of the American Psychiatric Association Meeting in San Francisco, California in May 2023.

I agree with my cardholder policy and I authorize the full payment of the fees I have selected below. Cancellations prior to March 30th can be refunded minus $15 to cover credit card processing fees and staff time to coordinate the refund. After April 6th no fees will be refunded.

Transparency Statement: All Credit Card processing charges for this event will be associated with Nashville Center for Hope & Healing. This organization and Train Your Brain: Your Record of Care with TMS are donating time to organize this event, they have made the deposits and contracted with the venue for this event. This celebration is a fundraiser so all proceeds will be donated to Foundation for the Advancement of Clinical TMS (FACTMS). A copy of the full accounting of the event will be given to FACTMS. FACTMS has donated $5000.00 for the event's initiation.

Signature: *