Attendee Activities Form - Georgia Vascular Society

Contact Information

Name*

First Last

Practice Name*

Phone

Email

Choose Your Events

Which events are you interested in?

Sporting Clay
Golf Tournament
President's Tailgate

Sporting Clay

How many sporting clay tickets do you need?*

Price: $100.00

Please enter the names of each person participating.*

Golf Tournament

How many golf tickets do you need?*

Price: $150.00

Please enter the names of each person participating.*

President's Tailgate

How many adult tickets do you need?*

Price: $75.00

Please enter the names of each adult participating.*

Do you plan to bring children ages 4 to 18?*

Yes
No

How many child tickets do you need? (No charge for 3 and under)

Price: $25.00

Please enter the names of children ages 4 and older participating.

Payment

Total

$0.00

How would you like to pay?*

Credit Card
Check

Please make checks payable to Georgia Vascular Society, Inc.

Tax ID# 45-4588488

Mail to:

Georgia Vascular Society, Inc.
c/o Burkhardt Planning & Consulting
Attn: Liz Sullivan-Burkhardt, Executive Director
2520 Vestal Parkway East #238
Vestal, New York 13850

Credit Card*

Card Details

Cardholder Name