HISTORY OF DERMATOLOGY SOCIETY
39th Annual Meeting – March 15, 2012 – Thursday – San Diego, California Price # Tickets Amount
10 AM Tour and Lecture The San Diego Museum of Art, 1450 El Prado, Balboa Park Free    
12 Noon to 1 PM Luncheon Palomar San Diego Hotel, 1047 5th Avenue $40
1:30 PM to 5 PM  Afternoon Seminar Palomar San Diego Hotel, 1047 5th Avenue $50 non-members
Free for members 
7 PM Annual Banquet – Cocktail Reception Salvatore's Cucina Italiana,
750 Front Street		 $95
8 PM Dinner and Samuel J. Zakon Lecture
  Dr. Martin Black
  Membership Dues   $185
Registrant’s Name
Gender M F
Title MD PhD MD,PhD MS Other
Specialty Dermatologist Other
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Total amount due in $US which may be paid by Visa MasterCard Check
By check to: Anthony V. Benedetto, Secretary/Treasurer of the History of Dermatology Society / 2221 Garrett Road, Drexel Hill, PA 19026
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Signature if by fax or mail ___________________________________________
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