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Houston Gerontological Society
Membership Application

The mission of the Houston Gerontological Society (HGS) is to inform, exchange and disseminate knowledge and information between and among varied professionals serving the elderly and to reward educational growth through scholarships in order to strengthen and enhance current and future services for the geriatric populations.

* Required Field

First Name *

Last Name *

Title (Optional)

Employer (Optional)

Mailing Address *

City *

State * (ex. TX)

Zip *

Telephone *

Email *

Membership Levels & Benefits *

Sustaining Annual Member
Benefits
• Attend all four dinner educational programs at no charge
• Bring a guest at no charge to two educational programs
(RSVP required)

$85

Supporting Annual Member
Benefits
• Member rate ($15) for all dinner educational programs
• Bring one guest to one educational program at no charge
(RSVP required)

$35

Student Member
Benefits
• All benefits of a sustaining annual membership

$15

Get involved:
Please indicate which, if any, committee you would like to join:

Membership Committee Program Planning Committee

Scholarship Committee Communications Committee

Total Membership Cost

Total Membership Dues

Important:		Please print your application and make a check payable to HGS
		Mailing Address Houston Gerontological Society Attn: Treasurer P.O. Box 271534 Houston, Texas 77277-1534

Membership is based on a calendar year, starting in January and ending in December. Membership benefits are non-transferable. All non-members must pay $25 to attend a dinner educational program.