INVOICE
BASIC: $ 350.00
Dear Society Member,
On behalf of Dr. Corey S. Maas, President, Dr. James Newman, Treasurer, and Amy-McGee-Moser, Executive
Vice President, we wish to thank you for your past support and to ask for your continued support in the
coming years.
Your renewal dues: Your renewal dues are very important and have a direct impact on your ability to provide
quality care. Each member’s dues go towards paying for a listing on our website, as well as making available a
discount for the ACLS training at our annual meeting. In addition, your dues also go towards paying for our
delegate seat during the CMA annual legislative session. We would like to remind you that your renewal helps
us keep our CMA membership status and delegate seat, which is more important at our State level than that
of the National level. Over 150 of your Colleagues are members, so why not renew now?
Winter Conference: We look forward to seeing you at this year’s conference. We will again be meeting at Lake
Tahoe, from Thursday, March 5, 2015 - Sunday, March 8, 2015.
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Please mail your payment to: CSFPS, 2400 Clay St., San Francisco, CA 94115 OR renew and submit
payment online: http://www.csfps.org/physicians
Name:________________________________________________________________________
Address:______________________________________________________________________
City:_______________________________________CA, Zip:___________________________
Phone:_________________________________Fax:___________________________________
E-mail:______________________________Web page: www.___________________________
Member in good standing with the American Academy of Facial Plastic and Reconstructive
Surgery?
Yes ( ) No ( )
Member in good standing with the California Medical Association?
Yes ( ) No ( )
Any Judgments or pending legal or other actions for unprofessional or negligent conduct?
( ) Yes No ( )
Signature:
____________________________________________________________