TNS Resident Stipend Form

Hey Resident and Fellow Members!
The TNS offers a generous housing stipend to residents who attend the meeting. Residents and Fellows will be reimbursed for a one night stay at the host hotel (or one of equal or lesser value of the special TNS Room Rate), tax, and self-parking.

To apply, please fill out the form below.

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* 1. Full Name:

First Name:

Middle Name:

Last Name:

Suffix:

Designation (MD, DO, etc):

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* 2. Email Address:

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* 3. Residency Program:

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* 4. Residency Completion Date:

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* 5. Current Mailing Address:

Address 1

Address 2

City, State, Zipcode

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* 6. Will you attend the Friday Evening Welcome Reception?

Yes

No