MNS Member Update Form

Help ensure that we can reach you easily. Any information you provide will never be sold, distributed or used outside of Maine Neurological Society buisness.

Question Title

* 1. Enter your preferred contact information:

Name *

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Phone Number *

Question Title

* 2. Credentials

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* 3. Hospital or Practice Name

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* 4. Practice areas or specialty (select all that apply)

Stroke

Epilepsy

Neuro-immunology

Neuro-oncology

Memory Disorders

Headache

Multiple Sclerosis

Dementia

Movement Disorders

Pediatric Neurology

General Neurology

Stroke

Vascular Neurology

Neuromuscular Disorders

Sleep Disorders

Neonatal Neurology

Other (please specify)

Question Title

* 5. Membership Category

Regular Membership | $100 (available to physicians and APP's in Maine)

Retired Membership | $50 (available to fully retired physicians and APP's)

Regular Membership - Discounted | $50 (discount for Maine Medical Association Members and retired physicians)

Affiliate Membership | $50 (available to other health care practitioners actively engaged in the care of neurology patients)

Affiliate Membership - Discounted (discount for Affiliates who are also Maine Medical Association Members)

Student or Resident Membership | $0.00

If applying for the MMA discount, please include your member number below

Question Title

* 6. The Maine Neurological Society listserv is used to facilitate communication among the members. Use of the listserv is monitored to ensure communications are relevant and do not include propaganda.

Do you consent to participating in the MNS listserve?

Yes - add my email to the listserv

No - don't add my email to the listserv

MNS Member Update Form

Question Title

* 1. Enter your preferred contact information:

Question Title

* 2. Credentials

Question Title

* 3. Hospital or Practice Name

Question Title

* 4. Practice areas or specialty (select all that apply)

Question Title

* 5. Membership Category

Question Title

* 6. The Maine Neurological Society listserv is used to facilitate communication among the members. Use of the listserv is monitored to ensure communications are relevant and do not include propaganda. Do you consent to participating in the MNS listserve?

* 6. The Maine Neurological Society listserv is used to facilitate communication among the members. Use of the listserv is monitored to ensure communications are relevant and do not include propaganda.

Do you consent to participating in the MNS listserve?