THE NEW ENGLAND HAND SOCIETY

36th ANNUAL MEETING REGISTRATION

Fill out the form below, then print it and mail it with your check to:

New England Hand Society
attn: Susan Schaffman
26 Riggs Avenue
West Hartford, CT 06107

Members:  $100 (OT/PT)  $150 (MD)
Non-Members:  $125 (OT/PT)  $175 (MD)
Students, Residents, and Fellows:  No charge

PLEASE MAKE CHECKS PAYABLE TO:
"NEW ENGLAND HAND SOCIETY"

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Address:
City:
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MD MD FACS NP RN

OTR/L OTR/L/CHT MS COTA

Student Resident Other


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