PSR Sacramento: Join PSR

Contact Information

Prefix:

None Dr. Mr. Mrs. Ms. Miss

First Name:*

Last Name:*

Suffix:

Address:

City:

State:

Zip:

Home Phone:

( ) -

Work Phone:

( ) -

E-mail:

Membership

Sponsoring Member (Physicians & other health professionals w/ doctoral degrees):

$125

Supporting Member (Residents, Interns, Nurses, other health professionals, concerned citizens):

$50

Retired Member:

$35

Student:

$15

Donation

General Donation Amount:

Directed Scholarship Fund Donation Amount:

Annual Dinner Reservations

Make reservations for the annual dinner hosted jointly by Americans Against Gun Violence and PSR/Sacramento, featuring a keynote address by Dr. Michael North of Scotland entitled, "Gun Control in Great Britain after the 1996 Dunblane Primary School Mass Shooting: A Model for the USA."

Date: Saturday, October 21
Time: Check-in and Social Hour 6-7 PM; Dinner and Program 7-9:30 PM
Place: Hilton Arden West, 2200 Harvard Street, Sacramento
Cost per person: $60

Please enter your first and last name in the fields under 'Contact Information,' above, before proceeding to make your dinner reservation(s).

Number of Reservations ($60 per person):

Name(s) of person(s) for whom you're making reservations and entrée choices (salmon, chicken or vegetarian). Include your own name and any titles, degrees, etc., that you'd like included on name badge(s).

Payment Method

PSR/Sacramento is a 501(c)(3) non-profit organization. Membership payments and donations are tax-deductible. Dinner/Lunch payments are not tax-deductible.

I will submit payment:

by sending a check to PSR Sacramento

with a secure credit card payment