Membership Survey

you can print this page and fill in the information below.

 

1. In order of importance, please number in order (1 - 5) issues that you would like to see the society address (1 = most important):

______ Educational conferences (bringing latest in cutting edge education)

______ Public education campaigns

______ Networking opportunities between PA neurologists

______ Third Party Payors

______ Malpractice Reform

______ Improving quality of care of neurology services in PA.(ie. increasing primary stroke centers in rural areas)

_____ Other, please list: ______________________________________

 

2. Would you be interested in a leadership position within the Pennsylvania Neurological Society?

( ) Yes ( ) No

If yes, what type of position? (you may choose more than one

_____ Executive committee

_____ Annual Meeting Committee

_____ Constitution/bylaws Committee

_____ Public Relations

_____ Legislative Committe

_____ Neuroimaging Committee

_____ Pediatric Neurology Committee

_____ Third Party Payor Committee

_____ Public Health Committee

_____ Other, please list: ______________________________________

 

3. Would you attend an annual Saturday and/or Sunday conference held in:

A. (yes or no) Hershey, PA

B. (yes or no) Rotating between Philadelphia, Pittsburgh, and Hershey

 

4. What aspects of the annual conference would most likely convince you to attend the conference:

________________________________________________________________

________________________________________________________________

________________________________________________________________

 

Name: _____________________________________________

Address: ______________________________________________

Contact Email: __________________________________________

Contact Phone number: _______________________________________

 

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