MAES/OHNS Membership Form
Please print form, complete & return to the Treasurer
at the address below.
City, State, Zip: ______________________________________________________________
Email:_____________________________ (We plan on email only for future correspondence.)
Website:_________________________________ (To be hyper linked on the MAES website)
[ ] I would like to pay my yearly dues of $400 and pay for dinners in advance (pays for all 4 dinners).
Please make checks payable to:
Metro Atlanta Educational Society for Otolaryngology - Head and Neck Surgery or MAES/OHNS Society
Please return to:
Joshua M Levy, MD, MPH
Assistant Professor, Emory University, Dpt of Otolaryngology Head & Neck Surgery
Emory Sinus, Nasal & Allergy Center
550 Peachtree Street, NE
Atlanta, GA 30308