Fill in # of Doctors and
# of Non-Docs then Enter Total
For Docs & Team Based Upon
Your Membership Level and the
Date by Which You Register

#

GG12

Other
GIC
Members

Gold
Member
Full Fee

Gold
Register
1/1/19
to
1/31/19

Gold
Register
by
12/31/18

Platinum
Member
Full Fee

Platinum
Register
1/1/19
to
1/31/19

Platinum
Register
by
12/31/18

Doctors

NC*

$1497

$1197

$997

$897

$897

$697

$597

Non-Doctor Team & Spouse

NC*

$1497

$1197

$997

$897

$897

$697

$597

First Name

Last Name

Email

SUBMIT