Houston Gerontological Society
Membership Application

The mission of the Houston Gerontological Society (HGS) is to disseminate knowledge to professionals in gerontology who are then encouraged to implement this information in order to strengthen and enhance current and future services for the geriatric population.
* Required Field
First Name *

Last Name *

Title (Optional)

Employer (Optional)

Email *
Mailing Address *

City *

State * (ex. TX)     

Zip *
Telephone *

Membership is based on a calendar year, starting in January and ending in December.  Membership benefits are non-transferable.  When available, contact hours will be offered at no charge.  Membership dues are payable at time of application by check or credit card.  Payments can be completed via credit card online at www.HGSociety.org.  See below for pay-by-mail details.

Please Check Appropriate Membership Level

 Corporate Annual Member (New) - $200  ($150.00 for employees of non-profits)
• Any two employees of company can attend all educational/dinner programs at no charge
• Opportunity to bring one guest to an educational program. Guest must pay $20 (RSVP required)

Sustaining Annual Member - $100
• Attend all educational/dinner programs at no charge
• Opportunity to bring one guest to an educational program. Guest must pay $20 (RSVP required)

Student/Ombudsman Member - $50
• Attend educational/dinner programs at no additional cost.

**All non-members must pay $25 to attend educational/dinner programs

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

 Membership Committee Program Planning Committee
 Scholarship Committee  Communications Committee

Membership dues can be paid via a credit card at www.HGSociety.org.  If you prefer to pay by check, please make check payable to Houston Gerontological Society and mail along with printed membership application to:

Houston Gerontological Society
C/O Greg Shelley
UTHealth Cizik School of Nursing
6901 Bertner AVE, Suite 573
Houston, TX  77030

Total Membership Cost

Total Membership Dues

Method of Payment:
 Check    Credit Card